Healthcare Provider Details

I. General information

NPI: 1730563669
Provider Name (Legal Business Name): GARY HUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 HIGHLAND AVE STE 202
SOMERVILLE MA
02144-2530
US

IV. Provider business mailing address

403 HIGHLAND AVE STE 202
SOMERVILLE MA
02144-2530
US

V. Phone/Fax

Practice location:
  • Phone: 781-205-9811
  • Fax:
Mailing address:
  • Phone: 781-205-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10000340
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: