Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 9681 | MA |
NPI | 1033492608 |
---|---|
Provider Name | Dr. Lauren Santucci |
First Address | Roxbury Crossing, MA 02120-3225 |
Second Address | Roxbury Crossing, MA 02120-3225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2011 |
Last Update Date | 23/04/2013 |