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General NPI Number Information
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NPI Number | 1063367282
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Entity Type | Organization
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Legal Business Name | NEUROTHRIVE
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 1492 HIGHLAND AVE STE 8
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City | NEEDHAM
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State | MA
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Zip | 02492-2606
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Country | US
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Telephone | 617-651-0233
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Fax |
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Provider Business Mailing Address
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Address Line | 613 HIGHLAND AVE
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City | NEEDHAM
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State | MA
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Zip | 02494-2235
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Country | US
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Telephone | 617-651-0233
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC NEUROLOGIST
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Name | WENDY XIAO HERMAN
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Credential | MD, PHD
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Telephone | 617-651-0233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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