MEDICARE: DR. LAURIE A LIVINGSTON ED.D.

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	103TC0700X	Clinical Psychologist	3623	MA

General Provider Information

NPI Number	:	1821152612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE A LIVINGSTON ED.D.

Provider Business Mailing Address
First Line	:	1131 BEACON ST
Second Line	:	SUITE C-1
City	:	BROOKLINE
State	:	MA
Zip	:	02446-5531
Country	:	US
Telephone Number	:	617-734-5779
Fax Number	:	617-524-0801

Provider Business Practice Location Address
First Line	:	1131 BEACON ST
Second Line	:	SUITE C-1
City	:	BROOKLINE
State	:	MA
Zip	:	02446-5531
Country	:	US
Telephone Number	:	617-734-5779
Fax Number	:	617-524-0801

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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