1194811448 NPI number — DR. DANIELLE ANDREA WAHBA M.A., PSY.D.

Table of content: DR. DANIELLE ANDREA WAHBA M.A., PSY.D. (NPI 1194811448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194811448 NPI number — DR. DANIELLE ANDREA WAHBA M.A., PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAHBA
Provider First Name:
DANIELLE
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.A., PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194811448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
354 W BOYLSTON ST STE 224
Provider Second Line Business Mailing Address:
FAMILY WORKS PSYCHOLOGICAL AND ASSESSMENT SERVICES, LLC
Provider Business Mailing Address City Name:
WEST BOYLSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01583-2373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-791-1454
Provider Business Mailing Address Fax Number:
508-791-3318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
354 W BOYLSTON ST
Provider Second Line Business Practice Location Address:
SUITE 224
Provider Business Practice Location Address City Name:
WEST BOYLSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01583-2373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-791-1454
Provider Business Practice Location Address Fax Number:
508-791-3318
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  8302 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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