Healthcare Provider Details

I. General information

NPI: 1063035566
Provider Name (Legal Business Name): HERMINE MUSKAT ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 WASHINGTON ST APT 521
BOSTON MA
02118-2170
US

IV. Provider business mailing address

1313 WASHINGTON ST APT 521
BOSTON MA
02118-2170
US

V. Phone/Fax

Practice location:
  • Phone: 617-877-5722
  • Fax:
Mailing address:
  • Phone: 617-877-5722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number1597
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1597-PY-PR
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1597-PY-PR
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: