Healthcare Provider Details

I. General information

NPI: 1346161791
Provider Name (Legal Business Name): LAHEY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BURLINGTON MALL ROAD
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

41 BURLINGTON MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 781-744-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN D MOFFATT-BRUCE
Title or Position: PRESIDENT
Credential: MD
Phone: 781-744-8594