Healthcare Provider Details

I. General information

NPI: 1366593386
Provider Name (Legal Business Name): JOHN MONROE CUETARA ED.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MILL ST SUITE 407
ARLINGTON MA
02476-4784
US

IV. Provider business mailing address

41 PITCHER AVE
MEDFORD MA
02155-2106
US

V. Phone/Fax

Practice location:
  • Phone: 781-488-3294
  • Fax: 781-488-3254
Mailing address:
  • Phone: 781-488-3294
  • Fax: 781-488-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7201
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: