Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1629564513 |
---|---|
Provider Name | Dr. Renee Jane Outland |
First Address | Somerville, MA 02144-3113 |
Second Address | Cambridge, MA 02138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2018 |
Last Update Date | 06/10/2018 |