Provider Demographics
NPI:1962447714
Name:WALBRIDGE, MARIE MARGARET (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:MARGARET
Last Name:WALBRIDGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:61 CHAUNCY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2333
Mailing Address - Country:US
Mailing Address - Phone:781-348-3900
Mailing Address - Fax:781-348-2132
Practice Address - Street 1:250 POND ST
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5351
Practice Address - Country:US
Practice Address - Phone:781-348-3900
Practice Address - Fax:781-348-2132
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA6107103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0525928Medicaid
MA751147OtherTUFTS HEALTH PLAN
MAW04900OtherBLUE CROSS BLUE SHIELD
MA043558206OtherTAX ID
MAW04900Medicare ID - Type Unspecified