Provider Demographics
NPI:1053638841
Name:BRIGGS, RENEE MICELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:MICELLE
Last Name:BRIGGS
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 1:445 MARRETT RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7714
Mailing Address - Country:US
Mailing Address - Phone:781-652-8544
Mailing Address - Fax:
Practice Address - Street 1:445 MARRETT RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7714
Practice Address - Country:US
Practice Address - Phone:781-652-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical