Provider Demographics
NPI:1639463359
Name:TOUSSAINT, KARINE LEA (PHD)
Entity Type:Individual
Prefix:
First Name:KARINE
Middle Name:LEA
Last Name:TOUSSAINT
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 1:809 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3900
Mailing Address - Country:US
Mailing Address - Phone:781-325-8111
Mailing Address - Fax:781-863-6102
Practice Address - Street 1:809 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3900
Practice Address - Country:US
Practice Address - Phone:781-325-8111
Practice Address - Fax:781-863-6102
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical