Provider Demographics
NPI:1487710406
Name:HERRINGSHAW, LEE R (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:R
Last Name:HERRINGSHAW
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 1:1696 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1803
Mailing Address - Country:US
Mailing Address - Phone:617-501-4488
Mailing Address - Fax:617-864-0538
Practice Address - Street 1:1696 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1803
Practice Address - Country:US
Practice Address - Phone:617-501-4488
Practice Address - Fax:617-864-0538
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA7383103TA0700X, 103TC0700X, 103T00000X, 103TP2701X
103TB0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000W05805OtherBLUE CROSS BLUE SHIELD
MA0526568Medicaid
MAW50311Medicare ID - Type Unspecified