Provider Demographics
NPI:1154551257
Name:WALDHETER, MIRIAM ROSE (PHD)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:ROSE
Last Name:WALDHETER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MIRIAM
Other - Middle Name:ROSE
Other - Last Name:FRANKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:18 GROVE ST STE 9
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7705
Mailing Address - Country:US
Mailing Address - Phone:617-819-4707
Mailing Address - Fax:
Practice Address - Street 1:18 GROVE ST STE 9
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7705
Practice Address - Country:US
Practice Address - Phone:617-819-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA9726103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program