Provider Demographics
NPI:1679619431
Name:KREMGOLD-MYER, ANITA (ED)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:KREMGOLD-MYER
Suffix:
Gender:F
Credentials:ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MALL RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4517
Mailing Address - Country:US
Mailing Address - Phone:781-229-6700
Mailing Address - Fax:781-229-6701
Practice Address - Street 1:60 MALL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4517
Practice Address - Country:US
Practice Address - Phone:781-229-6700
Practice Address - Fax:781-229-6701
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical