Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 13874 | MA |
N | 225XM0800X | Mental Health |
NPI | 1528651759 |
---|---|
Provider Name | Thomas James Baird Heneghan |
First Address | Belmont, MA 02478-2438 |
Second Address | Arlington, MA 02474-6700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2021 |
Last Update Date | 18/02/2021 |