Provider Demographics
NPI:1669917381
Name:MAUGHAN, ANGELINE (PHD)
Entity type:Individual
Prefix:
First Name:ANGELINE
Middle Name:
Last Name:MAUGHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 920084
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-0001
Mailing Address - Country:US
Mailing Address - Phone:781-277-7370
Mailing Address - Fax:
Practice Address - Street 1:10 NORFOLK ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-3211
Practice Address - Country:US
Practice Address - Phone:781-277-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9601103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist