Healthcare Provider Details

I. General information

NPI: 1477602704
Provider Name (Legal Business Name): RACHEL WISEMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MASSACHUSETTS AVE SUITE 301
ARLINGTON MA
02474-8448
US

IV. Provider business mailing address

180 MASSACHUSETTS AVE SUITE 301
ARLINGTON MA
02474-8448
US

V. Phone/Fax

Practice location:
  • Phone: 781-643-3800
  • Fax: 781-643-3803
Mailing address:
  • Phone: 781-643-3800
  • Fax: 781-643-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8045
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: