Doctor Name: | DR. SHERYL THAU BARDIN |
NPI Number: | 1033118450 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 3688 |
Business Practice Address: | 17 Henshaw St Brighton, MA - 021352905 |
Business Phone Number: | 6173320205 |
Business Fax Number: | |
Mailing Address: | 17 Henshaw St, BRIGHTON |
State: | MA |
Postal Code: | 021352905 |
Phone Number: | 6173320205 |
Fax Number: | |
NPI Enumeration Date: | 07/18/2005 |
NPI Last Update Date: | 10/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 3688 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |