Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 386 | MA |
Y | 103TC0700X | Clinical Psychologist | 386 | MA |
NPI | 1003984725 |
---|---|
Provider Name | Ms. Marcia Dana Huberman |
First Address | Newton Centre, MA 02459-2505 |
Second Address | Newton Centre, MA 02459-2505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W06145 | BLUE CROSS BLUE SHIELD MA (01) | MA |