Evan Joshua Waldheter, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

09054 Issued in MA

Practice address

77 Massachusetts Ave # E23-368
Cambridge, MA 02139-4307

Phone

(617) 784-6559

NPI assigned

Jun 13, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Massachusetts Institute of Technology

  dba MIT Health

  • Multi-Specialty Clinic/Center
  • Cambridge, MA
  • NPI 1346308723
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525996800000",
    "number": "1356545149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 MASSACHUSETTS AVE # E23-368",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021394307",
            "telephone_number": "617-784-6559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 MASSACHUSETTS AVE # E23-368",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021394307",
            "telephone_number": "617-784-6559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDHETER",
        "first_name": "EVAN",
        "middle_name": "JOSHUA",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-13",
        "last_updated": "2018-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MA",
            "license": "09054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madeline Anne Wagner, PH.D,
• Phyllis J Wagner, MD
• Rebecca Anne Waintrup, PSY.D.
• Cynthia Waite, ANP-C
• Barbara Jones Waksman, RDH
• Lydia Waldo, LCSW
• Emily L Waldon, P.A.
• Sarah Waldron, LCSW
• Walgreen Co (Walgreens #06767)
• Walgreen Co (Walgreens #17165)

• Clinical Psychologist in Cambridge, MA
• Providers in Cambridge, MA by specialty
• Clinical Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.