MEDICARE: DR. JULIA WYMER SLATKIN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	10711	MA

General Provider Information

NPI Number	:	1265831739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA WYMER SLATKIN PHD

Provider Business Mailing Address
First Line	:	45 WALDEN ST
Second Line	:
City	:	CONCORD
State	:	MA
Zip	:	01742-2533
Country	:	US
Telephone Number	:	978-212-9833
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 WALDEN ST
Second Line	:
City	:	CONCORD
State	:	MA
Zip	:	01742-2533
Country	:	US
Telephone Number	:	978-212-9833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2014
Last Update Date	:	09/19/2024

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