Provider Demographics
NPI:1194517623
Name:STODDARD, EMILY M (MA, EDS)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:STODDARD
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:M
Other - Last Name:STODDARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, EDS
Mailing Address - Street 1:122 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2230
Practice Address - Country:US
Practice Address - Phone:617-635-8510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty