Healthcare Provider Details

I. General information

NPI: 1154451177
Provider Name (Legal Business Name): DR. KATRIN TODD WEIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATRIN ROUSE WEIR ED.D

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST SUITE #1
INDIAN ORCHARD MA
01151-1228
US

IV. Provider business mailing address

4 HITCHING POST LN
WILBRAHAM MA
01095-1712
US

V. Phone/Fax

Practice location:
  • Phone: 413-543-5865
  • Fax: 413-543-2202
Mailing address:
  • Phone: 413-599-1701
  • Fax: 413-543-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number6803
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: