Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 13822 | MA |
NPI | 1851984009 |
---|---|
Provider Name | Lindsey Warren |
First Address | Medford, MA 02155-3258 |
Second Address | Medford, MA 02155-3258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2021 |
Last Update Date | 18/02/2021 |