Healthcare Provider Details

I. General information

NPI: 1285646695
Provider Name (Legal Business Name): PAMELA WIEGARTZ PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 E CENTRAL ST STE 247
FRANKLIN MA
02038-1317
US

IV. Provider business mailing address

279 E CENTRAL ST STE 247
FRANKLIN MA
02038-1317
US

V. Phone/Fax

Practice location:
  • Phone: 617-429-8584
  • Fax:
Mailing address:
  • Phone: 617-429-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number071006114
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8952
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: