Provider Demographics
NPI:1972565208
Name:SETH, NITI (EDD)
Entity Type:Individual
Prefix:MS
First Name:NITI
Middle Name:
Last Name:SETH
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MASSACHUSETTS AVENUE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:614-642-3586
Mailing Address - Fax:617-489-6925
Practice Address - Street 1:875 MASSACHUSETTS AVENUE
Practice Address - Street 2:SUITE 24
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:614-642-3586
Practice Address - Fax:617-489-6925
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4954103TC0700X
MAPY4954-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical