Healthcare Provider Details

I. General information

NPI: 1699631119
Provider Name (Legal Business Name): ELIZABETH HALSTEAD M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LIBBY HALSTEAD M.A.

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BREWSTER ST
CAMBRIDGE MA
02138-2203
US

IV. Provider business mailing address

25 BREWSTER ST
CAMBRIDGE MA
02138-2203
US

V. Phone/Fax

Practice location:
  • Phone: 617-933-9371
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: