Provider Demographics
NPI:1689893547
Name:WEBB, ANN HAGAN (EDD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:HAGAN
Last Name:WEBB
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:KATHLEEN
Other - Last Name:HAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:303 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5339
Mailing Address - Country:US
Mailing Address - Phone:781-239-1182
Mailing Address - Fax:781-871-0306
Practice Address - Street 1:303 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5339
Practice Address - Country:US
Practice Address - Phone:781-239-1182
Practice Address - Fax:781-871-0306
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3245103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03343Medicare ID - Type UnspecifiedPSYCHOLOGIST