Healthcare Provider Details

I. General information

NPI: 1891856076
Provider Name (Legal Business Name): KATHRYN D HEWETT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BINNEY ST PEDIATRIC ONCOLOGY D317
BOSTON MA
02115
US

IV. Provider business mailing address

3 ELM STREET
HARVARD MA
01451
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-2098
  • Fax: 617-632-5567
Mailing address:
  • Phone: 978-456-3112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4359
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: