Healthcare Provider Details

I. General information

NPI: 1487710406
Provider Name (Legal Business Name): LEE R. HERRINGSHAW PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1696 MASSACHUSETTS AVE SUITE #2
CAMBRIDGE MA
02138-1803
US

IV. Provider business mailing address

1696 MASSACHUSETTS AVE SUITE #2
CAMBRIDGE MA
02138-1803
US

V. Phone/Fax

Practice location:
  • Phone: 617-501-4488
  • Fax: 617-864-0538
Mailing address:
  • Phone: 617-501-4488
  • Fax: 617-864-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberMA7383
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberMA7383
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberMA7383
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberMA7383
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: