Provider Demographics
NPI:1659432573
Name:LITTMAN, MADELEINE I (PHD)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:I
Last Name:LITTMAN
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 1:15 COURT SQUARE
Mailing Address - Street 2:SUITE 830
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108
Mailing Address - Country:US
Mailing Address - Phone:617-723-7650
Mailing Address - Fax:617-723-7654
Practice Address - Street 1:15 COURT SQUARE
Practice Address - Street 2:SUITE 830
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108
Practice Address - Country:US
Practice Address - Phone:617-723-7650
Practice Address - Fax:617-723-7654
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMASS2466103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A018251OtherPBH
723704OtherTUFTS
W03659Medicare ID - Type Unspecified