Basic Information
| Provider Information | |||||||||
| NPI: | 1780727321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KREDER | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | VERONIQUE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 203 PERHAM ST | ||||||||
| Address2: | |||||||||
| City: | WEST ROXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021323706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173278119 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20 EASTBROOK RD | ||||||||
| Address2: | |||||||||
| City: | DEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020262075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813299365 | ||||||||
| FaxNumber: | 7813024635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 3112 | MA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.