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General NPI Number Information
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NPI Number | 1770798779
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Entity Type | Individual
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Provider Name | MICHELLE RAE SCHUDER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 1577 BEACON ST THIRD FLOOR PSYCHOTHERAPY SUITES
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City | BROOKLINE
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State | MA
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Zip | 02446-4602
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Country | US
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Telephone | 617-739-9642
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Fax |
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Provider Business Mailing Address
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Address Line | 1577 BEACON ST THIRD FLOOR PSYCHOTHERAPY SUITES
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City | BROOKLINE
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State | MA
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Zip | 02446-4602
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Country | US
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Telephone | 617-739-9642
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Fax |
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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 | 8541
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License Number State | MA
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