Provider Demographics
NPI:1780232553
Name:EMMA NATHANSON, PSYD LLC
Entity Type:Organization
Organization Name:EMMA NATHANSON, PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NATHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:978-758-9335
Mailing Address - Street 1:40 CRESCENT ST OFC 201
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4313
Mailing Address - Country:US
Mailing Address - Phone:978-758-9335
Mailing Address - Fax:
Practice Address - Street 1:40 CRESCENT ST OFC 201
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4313
Practice Address - Country:US
Practice Address - Phone:978-758-9335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health