Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 0005 | MA |
N | 103G00000X | Clinical Psychologist | 0005 | MA |
N | 103TC0700X | Clinical Psychologist | 0005 | MA |
NPI | 1003358706 |
---|---|
Provider Name | Gretchen Dittrich |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2016 |
Last Update Date | 11/11/2016 |