Provider Demographics
NPI:1144579897
Name:BARRETT-MODEL, HEIDI MELINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:MELINDA
Last Name:BARRETT-MODEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 TUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6223
Mailing Address - Country:US
Mailing Address - Phone:617-413-6473
Mailing Address - Fax:
Practice Address - Street 1:18 TUCKER AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6223
Practice Address - Country:US
Practice Address - Phone:617-413-6473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-09
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9568103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical