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General NPI Number Information
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NPI Number | 1942718143
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Entity Type | Organization
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Legal Business Name | JULIA TADDONIO, PSYD, PC
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 01/22/2018
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Provider Practice Location Address
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Address Line | 75 RAILROAD AVE UNIT E
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City | SOUTH HAMILTON
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State | MA
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Zip | 01982-2218
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Country | US
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Telephone | 802-999-1286
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Fax |
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Provider Business Mailing Address
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Address Line | 118 PLEASANT ST APT 1
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City | CAMBRIDGE
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State | MA
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Zip | 02139-4451
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Country | US
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Telephone | 802-999-1286
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIA TADDONIO
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Credential | PSYD
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Telephone | 802-999-1286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 10671
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License Number State | MA
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