Provider Demographics
NPI:1598114308
Name:TUMILTY, MEREDITH (PSYD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:TUMILTY
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 1:396 WASHINGTON ST # 266
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6209
Mailing Address - Country:US
Mailing Address - Phone:855-438-8331
Mailing Address - Fax:
Practice Address - Street 1:396 WASHINGTON ST # 266
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-6209
Practice Address - Country:US
Practice Address - Phone:855-438-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10448103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35SI00691700OtherNEW JERSEY DIVISION OF CONSUMER AFFAIRS
CT4247OtherSTATE OF CONNECTICUT
MA10448OtherBOARD OF REGISTRATION OF PSYCHOLOGISTS