Provider Demographics
NPI:1831211853
Name:LAMTO, MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:LAMTO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 MASS AVE STE 2-1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3072
Mailing Address - Country:US
Mailing Address - Phone:617-645-0505
Mailing Address - Fax:
Practice Address - Street 1:872 MASS AVE STE 2-1
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3072
Practice Address - Country:US
Practice Address - Phone:617-645-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8525103TC0700X, 103TC2200X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06567OtherBCBS MASSACHUSETTS
MA60054OtherCHICKERING
W06567OtherBCBS
MA7987851OtherAETNA