Healthcare Provider Details

I. General information

NPI: 1689731747
Provider Name (Legal Business Name): MARY KATHLEEN OWENS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WALPOLE ST STE 6
NORWOOD MA
02062-3315
US

IV. Provider business mailing address

80 COLBURN ST
WESTWOOD MA
02090-3706
US

V. Phone/Fax

Practice location:
  • Phone: 781-551-4455
  • Fax: 781-255-9898
Mailing address:
  • Phone: 781-461-5876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLM4461
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: