Healthcare Provider Details

I. General information

NPI: 1518220433
Provider Name (Legal Business Name): ABBY ALTMAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 LONGWOOD AVE 4TH FLOOR
BOSTON MA
02115-5804
US

IV. Provider business mailing address

221 LONGWOOD AVE 4TH FLOOR
BOSTON MA
02115-5804
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-6753
  • Fax: 617-975-0828
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number9507
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS017076
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: