Provider Demographics
NPI:1457023053
Name:PINHEIRO PENNA DE MELLO BARRETO, LUISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:
Last Name:PINHEIRO PENNA DE MELLO BARRETO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LUISA
Other - Middle Name:
Other - Last Name:BARRETO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:115 MILL ST
Mailing Address - Street 2:OCDI JUNIOR
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1048
Mailing Address - Country:US
Mailing Address - Phone:617-855-4520
Mailing Address - Fax:
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:OCDI JUNIOR
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1048
Practice Address - Country:US
Practice Address - Phone:617-855-4520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSY5000306103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty