Provider Demographics
NPI:1487003745
Name:LUNDQUIST, TESSA STRATTON (PHD)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:STRATTON
Last Name:LUNDQUIST
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 1:169 LIBBEY PKWY
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3101
Mailing Address - Country:US
Mailing Address - Phone:781-551-0999
Mailing Address - Fax:781-551-3396
Practice Address - Street 1:169 LIBBEY PKWY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3101
Practice Address - Country:US
Practice Address - Phone:781-551-0999
Practice Address - Fax:781-551-3396
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAIN PROCESS103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical