Healthcare Provider Details

I. General information

NPI: 1295789642
Provider Name (Legal Business Name): MARILYN DENISE RITHOLZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOSLIN PL
BOSTON MA
02215-5306
US

IV. Provider business mailing address

33 BEDFORD ST SUITE 20
LEXINGTON MA
02420-4319
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-2594
  • Fax: 617-713-3410
Mailing address:
  • Phone: 781-863-1439
  • Fax: 781-863-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4198
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: