Provider Demographics
NPI:1235366279
Name:GEHRENBECK-SHIM, ANNE R (PHD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:R
Last Name:GEHRENBECK-SHIM
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 1:11 BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-7003
Mailing Address - Country:US
Mailing Address - Phone:617-595-8476
Mailing Address - Fax:617-292-9272
Practice Address - Street 1:11 BEAVER ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-7003
Practice Address - Country:US
Practice Address - Phone:617-595-8476
Practice Address - Fax:617-292-9272
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7550103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist