Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 6172 | MA |
N | 103TC0700X | Clinical Psychologist | 6172 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1134272248 |
---|---|
Provider Name | Martha Jane Bestebreurtje |
First Address | Cambridge, MA 02139-4445 |
Second Address | Cambridge, MA 02139-4450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |