Provider Demographics
NPI:1477602704
Name:WISEMAN, RACHEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-8448
Mailing Address - Country:US
Mailing Address - Phone:781-643-3800
Mailing Address - Fax:781-643-3803
Practice Address - Street 1:180 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8448
Practice Address - Country:US
Practice Address - Phone:781-643-3800
Practice Address - Fax:781-643-3803
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8045103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06379OtherBLUE CROSS PROVIDER NUMBE