Provider Demographics
NPI:1346396710
Name:KLAGSBRUN, JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:KLAGSBRUN
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 1:173 MOUNT AUBURN ST
Mailing Address - Street 2:ROOM 11
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4005
Mailing Address - Country:US
Mailing Address - Phone:617-924-8515
Mailing Address - Fax:781-862-0355
Practice Address - Street 1:1 EUSTIS ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5611
Practice Address - Country:US
Practice Address - Phone:781-861-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1790103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist