Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1884 | MA |
Y | 103G00000X | Clinical Psychologist | 1884 | MA |
Y | 103TC0700X | Clinical Psychologist | 1884 | MA |
NPI | 1356541916 |
---|---|
Provider Name | Dr. Margery Kistin Anzalone |
First Address | Onset, MA 02558-1629 |
Second Address | West Barnstable, MA 02668-1142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 23/07/2007 |