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General NPI Number Information
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NPI Number | 1235104050
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Entity Type | Individual
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Provider Name | NANCY RUTH CETLIN EDD
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Gender | Female
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 264 BEACON ST FOURTH FLOOR
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City | BOSTON
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State | MA
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Zip | 02116
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Country | US
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Telephone | 617-267-5433
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Fax | 617-782-6764
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Provider Business Mailing Address
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Address Line | 141 BROOKS ST UNIT 1
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City | BRIGHTON
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State | MA
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Zip | 02135
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Country | US
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Telephone | 617-254-0284
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Fax | 617-782-6764
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3514
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301002901
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License Number State | MI
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