Healthcare Provider Details

I. General information

NPI: 1548990112
Provider Name (Legal Business Name): MARTHA ZAJAC PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA FAHLGREN PH.D.

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE
BOSTON MA
02130-4817
US

IV. Provider business mailing address

150 S HUNTINGTON AVE # 116B
BOSTON MA
02130-4817
US

V. Phone/Fax

Practice location:
  • Phone: 857-364-3190
  • Fax:
Mailing address:
  • Phone: 857-364-6859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11938
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11938
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: