Provider Demographics
NPI:1528214376
Name:ASTRACHAN, TAL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAL
Middle Name:
Last Name:ASTRACHAN
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 1:48 GROVE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2500
Mailing Address - Country:US
Mailing Address - Phone:617-475-0884
Mailing Address - Fax:
Practice Address - Street 1:48 GROVE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2500
Practice Address - Country:US
Practice Address - Phone:617-475-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical