MEDICARE: DR. KATHERINE LOU PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0700X	Adult Development & Aging Psychologist	10493	MA
2	103T00000X	Psychologist	10493	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285085159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE LOU PSY.D.

Provider Business Mailing Address
First Line	:	8709 BRAY VISTA WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95624-1713
Country	:	US
Telephone Number	:	617-366-2550
Fax Number	:	617-340-3733

Provider Business Practice Location Address
First Line	:	75 ARLINGTON ST FL 5
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02116-3936
Country	:	US
Telephone Number	:	617-366-2550
Fax Number	:	617-340-3733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	01/09/2023

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