Healthcare Provider Details

I. General information

NPI: 1285085159
Provider Name (Legal Business Name): KATHERINE LOU PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 01/09/2023
Certification Date: 01/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARLINGTON ST FL 5
BOSTON MA
02116-3936
US

IV. Provider business mailing address

8709 BRAY VISTA WAY
ELK GROVE CA
95624-1713
US

V. Phone/Fax

Practice location:
  • Phone: 617-366-2550
  • Fax: 617-340-3733
Mailing address:
  • Phone: 617-366-2550
  • Fax: 617-340-3733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number10493
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number10493
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: