MEDICARE: MARIE LAMTO PSY.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	8525	MA
2	103TC2200X	Clinical Child & Adolescent Psychologist	8525	MA
3	103TA0700X	Adult Development & Aging Psychologist	8525	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W06567	OTHER	MA	BCBS MASSACHUSETTS
2	60054	OTHER	MA	CHICKERING
3	W06567	OTHER		BCBS
4	7987851	OTHER	MA	AETNA

General Provider Information

NPI Number	:	1831211853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE LAMTO PSY.D.

Provider Business Mailing Address
First Line	:	872 MASS AVE STE 2-1
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3072
Country	:	US
Telephone Number	:	617-645-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	872 MASS AVE STE 2-1
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3072
Country	:	US
Telephone Number	:	617-645-0505
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	01/10/2020

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