Healthcare Provider Details

I. General information

NPI: 1215029657
Provider Name (Legal Business Name): HELENE A LIEB EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 DERBY ST SUITE 16
HINGHAM MA
02043
US

IV. Provider business mailing address

175 DERBY ST SUITE 16
HINGHAM MA
02043
US

V. Phone/Fax

Practice location:
  • Phone: 781-740-1546
  • Fax: 781-740-0212
Mailing address:
  • Phone: 781-740-1546
  • Fax: 781-740-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number4459
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: