Provider Demographics
NPI:1306999438
Name:ZOLDBROD, ALINE PENNY (PHD)
Entity type:Individual
Prefix:DR
First Name:ALINE
Middle Name:PENNY
Last Name:ZOLDBROD
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 1:12 RUMFORD RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-2209
Mailing Address - Country:US
Mailing Address - Phone:781-863-1877
Mailing Address - Fax:
Practice Address - Street 1:12 RUMFORD RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2209
Practice Address - Country:US
Practice Address - Phone:781-863-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2685 PSYCHOLOGY103T00000X
MA102407 LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical