Healthcare Provider Details

I. General information

NPI: 1831211853
Provider Name (Legal Business Name): MARIE LAMTO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 MASS AVE STE 2-1
CAMBRIDGE MA
02139-3072
US

IV. Provider business mailing address

872 MASS AVE STE 2-1
CAMBRIDGE MA
02139-3072
US

V. Phone/Fax

Practice location:
  • Phone: 617-645-0505
  • Fax:
Mailing address:
  • Phone: 617-645-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8525
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number8525
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number8525
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: