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General NPI Number Information
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NPI Number | 1386594125
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Entity Type | Organization
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Legal Business Name | THIRD WAVE THERAPY & TRAINING PLLC
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Dates
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Enumeration Date | 01/31/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 86 BAKER AVENUE EXT STE 307
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City | CONCORD
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State | MA
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Zip | 01742-2132
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Country | US
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Telephone | 508-366-7707
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Fax | 978-233-4696
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Provider Business Mailing Address
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Address Line | 86 BAKER AVENUE EXT STE 307
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City | CONCORD
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State | MA
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Zip | 01742-2132
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Country | US
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Telephone | 508-366-7707
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Fax | 978-233-4696
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Authorized Official
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Title or Position | MANAGER
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Name | DR. CHRISTY CLARK
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Credential | PHD
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Telephone | 774-261-0979
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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 |
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License Number State |
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