Provider Demographics
NPI:1861530206
Name:FALCONER, PAUL EDMUND (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EDMUND
Last Name:FALCONER
Suffix:
Gender:M
Credentials:PHD, LMHC
Other - Prefix:
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Mailing Address - Street 1:76 ELM ST
Mailing Address - Street 2:APT. 306
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2892
Mailing Address - Country:US
Mailing Address - Phone:617-912-7873
Mailing Address - Fax:617-557-1929
Practice Address - Street 1:25 STANIFORD ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2503
Practice Address - Country:US
Practice Address - Phone:617-912-7873
Practice Address - Fax:617-557-1929
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA5930101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health