Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1597-PY-PR | MA |
N | 103T00000X | Psychologist | 1597-PY-PR | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | 1597 | MA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103TC1900X | Counseling Psychologist | 1597-PY-PR | MA |
NPI | 1063035566 |
---|---|
Provider Name | Hermine Muskat |
First Address | Boston, MA 02118-2170 |
Second Address | Boston, MA 02118-2170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2020 |
Last Update Date | 19/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115923574 | 1597-PY-PR (01) | MA |