Healthcare Provider Details

I. General information

NPI: 1982936514
Provider Name (Legal Business Name): CHRISTOPHER WILLARD PSY. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2010
Last Update Date: 02/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON ST ST 306
WELLESLEY MA
02481-1711
US

IV. Provider business mailing address

32 BELMONT ST #1
SOMERVILLE MA
02143-2535
US

V. Phone/Fax

Practice location:
  • Phone: 617-909-7640
  • Fax:
Mailing address:
  • Phone: 617-909-7640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9151
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: