Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 5022 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 5022 | MA |
NPI | 1235295395 |
---|---|
Provider Name | Dr. Anthony Rao |
First Address | Lexington, MA 02421-5257 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2006 |
Last Update Date | 16/08/2007 |