Provider Demographics
NPI:1538432497
Name:TESSMAN, LORA HEIMS (PHD)
Entity type:Individual
Prefix:DR
First Name:LORA
Middle Name:HEIMS
Last Name:TESSMAN
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 1:82 KIRKSTALL ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-2246
Mailing Address - Country:US
Mailing Address - Phone:617-332-9778
Mailing Address - Fax:617-965-5270
Practice Address - Street 1:82 KIRKSTALL ROAD
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-2246
Practice Address - Country:US
Practice Address - Phone:617-332-9778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA306103TC0700X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical