Healthcare Provider Details

I. General information

NPI: 1720205941
Provider Name (Legal Business Name): HEIDI LEE WEBSTER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 DAMONMILL SQ SUITE 4C
CONCORD MA
01742-2858
US

IV. Provider business mailing address

26 3 PONDS RD
WAYLAND MA
01778-1719
US

V. Phone/Fax

Practice location:
  • Phone: 508-335-9705
  • Fax:
Mailing address:
  • Phone: 508-335-9705
  • Fax: 508-358-6231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number7856
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: