Healthcare Provider Details

I. General information

NPI: 1235295395
Provider Name (Legal Business Name): ANTHONY RAO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

15 MUZZEY ST 3RD FLOOR (BEHAVIORAL SOLUTIONS)
LEXINGTON MA
02421-5257
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6680
  • Fax: 617-730-0319
Mailing address:
  • Phone: 781-676-0028
  • Fax: 617-965-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number5022
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number5022
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: