Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 11406 | MA |
Y | 103T00000X | Psychologist | 11406 | MA |
NPI | 1013358464 |
---|---|
Provider Name | Peter Shea Ward |
First Address | Charlestown, MA 02129-2025 |
Second Address | Charlestown, MA 02129-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2013 |
Last Update Date | 02/03/2021 |