Provider Demographics
NPI:1275635716
Name:WALD, HEDY SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEDY
Middle Name:SUSAN
Last Name:WALD
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:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067
Mailing Address - Country:US
Mailing Address - Phone:781-424-2711
Mailing Address - Fax:866-372-7918
Practice Address - Street 1:4 FRANK LEARY WAY
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368
Practice Address - Country:US
Practice Address - Phone:781-424-2711
Practice Address - Fax:866-372-7918
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2008-08-18
Deactivation Date:2008-07-23
Deactivation Code:
Reactivation Date:2008-08-18
Provider Licenses
StateLicense IDTaxonomies
MA4772103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04594Medicare UPIN