Provider Demographics
NPI:1235295395
Name:RAO, ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:RAO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MUZZEY ST
Mailing Address - Street 2:3RD FLOOR (BEHAVIORAL SOLUTIONS)
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5257
Mailing Address - Country:US
Mailing Address - Phone:781-676-0028
Mailing Address - Fax:617-965-2240
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6680
Practice Address - Fax:617-730-0319
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5022103TB0200X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent