Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 9941 | MA |
Y | 103G00000X | Clinical Psychologist | 9941 | MA |
Y | 103TC0700X | Clinical Psychologist | 9941 | MA |
N | 103TH0004X | Health Psychologist | 9941 | MA |
N | 103TH0100X | Health Service | 9941 | MA |
NPI | 1114336096 |
---|---|
Provider Name | Dr. Alejandra Faust |
First Address | Bedford, MA 01730 |
Second Address | Bedford, MA 01730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2014 |
Last Update Date | 13/10/2016 |