Healthcare Provider Details

I. General information

NPI: 1265900328
Provider Name (Legal Business Name): DYNAMIC PSYCHOTHERAPY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2018
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 WASHINGTON ST STE 221
WELLESLEY MA
02481-6221
US

IV. Provider business mailing address

354 WASHINGTON ST STE 221
WELLESLEY MA
02481-6221
US

V. Phone/Fax

Practice location:
  • Phone: 617-435-9762
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. IRIT FELDMAN
Title or Position: OWNER
Credential: PSY.D.
Phone: 617-435-9762