Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 11522 | MA |
Y | 103T00000X | Psychologist | 11522 | MA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 11522 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 11522 | MA |
N | 103G00000X | Clinical Psychologist | 11522 | MA |
N | 103TC0700X | Clinical Psychologist | 11522 | MA |
N | 103TH0100X | Health Service | 11522 | MA |
NPI | 1063070191 |
---|---|
Provider Name | Dr. Joanna M Streck |
First Address | Boston, MA 02114-2509 |
Second Address | Boston, MA 02114-2606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2019 |
Last Update Date | 20/10/2021 |