Healthcare Provider Details

I. General information

NPI: 1609222116
Provider Name (Legal Business Name): KATIE TAWAKOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LINCOLN ST STE 203
FRAMINGHAM MA
01702-8264
US

IV. Provider business mailing address

117 OAK ST
NEEDHAM MA
02492-2223
US

V. Phone/Fax

Practice location:
  • Phone: 781-666-2711
  • Fax: 781-666-2712
Mailing address:
  • Phone: 781-354-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN200083
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: