Provider Demographics
NPI:1124385513
Name:WOOLBERT, NANCY LEONTINE (MA PSYCHOANALYSIS)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LEONTINE
Last Name:WOOLBERT
Suffix:
Gender:F
Credentials:MA PSYCHOANALYSIS
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:TINA
Other - Last Name:WOOLBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA PSYCHOANALYSIS
Mailing Address - Street 1:87 PLYMPTON ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-0737
Mailing Address - Country:US
Mailing Address - Phone:781-894-0311
Mailing Address - Fax:
Practice Address - Street 1:87 PLYMPTON ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-0737
Practice Address - Country:US
Practice Address - Phone:781-894-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X
MANOT LICENSED102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst