Provider Demographics
NPI:1770760381
Name:WANG, EDWARD K (PSYD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:K
Last Name:WANG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2933
Mailing Address - Country:US
Mailing Address - Phone:617-872-4234
Mailing Address - Fax:
Practice Address - Street 1:46 MEADOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2933
Practice Address - Country:US
Practice Address - Phone:617-872-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4625103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical