Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 9104 | MA |
Y | 103TC0700X | Clinical Psychologist | 9104 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 9104 | MA |
NPI | 1063594414 |
---|---|
Provider Name | Joshua Eagle |
First Address | Brookline, MA 02445-4445 |
Second Address | Brookline, MA 02445-4445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 25/05/2010 |