Healthcare Provider Details

I. General information

NPI: 1841524717
Provider Name (Legal Business Name): KATHLEEN MEAGHER PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR SUITE 328K
BEVERLY MA
01915-6115
US

IV. Provider business mailing address

100 CUMMINGS CTR SUITE 328K
BEVERLY MA
01915-6115
US

V. Phone/Fax

Practice location:
  • Phone: 617-899-6272
  • Fax: 781-592-2471
Mailing address:
  • Phone: 617-899-6272
  • Fax: 781-592-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8627
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0195572
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: