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General NPI Number Information
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NPI Number | 1669923801
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Entity Type | Organization
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Legal Business Name | HEIDI W. THERMENOS, PH.D., LLC
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 1101 BEACON ST SUITE 5 EAST
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City | BROOKLINE
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State | MA
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Zip | 02446-5587
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Country | US
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Telephone | 781-606-1962
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 BEACON ST SUITE 5 EAST
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City | BROOKLINE
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State | MA
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Zip | 02446-5587
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Country | US
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Telephone | 781-606-1962
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. HEIDI WENCEL THERMENOS
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Credential | PH.D.
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Telephone | 781-606-1962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 103140
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License Number State | MA
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