Healthcare Provider Details

I. General information

NPI: 1306999438
Provider Name (Legal Business Name): ALINE PENNY ZOLDBROD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 RUMFORD RD
LEXINGTON MA
02420-2209
US

IV. Provider business mailing address

12 RUMFORD RD
LEXINGTON MA
02420-2209
US

V. Phone/Fax

Practice location:
  • Phone: 781-863-1877
  • Fax:
Mailing address:
  • Phone: 781-863-1877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2685 PSYCHOLOGY
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102407 LICSW
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: