Healthcare Provider Details

I. General information

NPI: 1083884068
Provider Name (Legal Business Name): PRESIDENT & FELLOWS OF HARVARD COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MOUNT AUBURN ST
CAMBRIDGE MA
02138-4960
US

IV. Provider business mailing address

75 MOUNT AUBURN ST
CAMBRIDGE MA
02138-4960
US

V. Phone/Fax

Practice location:
  • Phone: 617-496-9506
  • Fax: 617-495-6059
Mailing address:
  • Phone: 617-496-9506
  • Fax: 617-495-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateMA

VIII. Authorized Official

Name: KATHLEEN M COLE
Title or Position: DIRECTOR, REVENUE CYCLE MGMT
Credential:
Phone: 617-496-9506