Healthcare Provider Details

I. General information

NPI: 1477742351
Provider Name (Legal Business Name): MANJU VACHHER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SOMERSET ROAD
BROOKLINE MA
02445
US

IV. Provider business mailing address

24 SOMERSET ROAD
BROOKLINE MA
02445
US

V. Phone/Fax

Practice location:
  • Phone: 617-739-0284
  • Fax: 617-739-0284
Mailing address:
  • Phone: 617-739-0284
  • Fax: 617-739-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4586
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: