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NPI Code Detail

MEDICARE: MARTHA A HAUSTON M.ED. M.A., L.M.H.C.

MEDICARE: MARTHA A HAUSTON M.ED. M.A., L.M.H.C.
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
1101YM0800XMental Health Counselor6752MA

General Provider Information

NPI Number : 1558516625
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA A HAUSTON M.ED. M.A., L.M.H.C.
Provider Business Mailing Address
First Line : 41 WASHINGTON AVE
Second Line : APT 3
City : WALTHAM
State : MA
Zip : 02453-5037
Country : US
Telephone Number : 617-792-7788
Fax Number :
Provider Business Practice Location Address
First Line : 21 GLEN AVE
Second Line :
City : CHELMSFORD
State : MA
Zip : 01824-2858
Country : US
Telephone Number : 978-256-0667
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2008
Last Update Date : 11/17/2008

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