Healthcare Provider Details

I. General information

NPI: 1124044375
Provider Name (Legal Business Name): KATHERINE MARY KALLIEL ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 FULTON ST
NORWOOD MA
02062
US

IV. Provider business mailing address

72 FULTON ST
NORWOOD MA
02062-2320
US

V. Phone/Fax

Practice location:
  • Phone: 781-769-4233
  • Fax:
Mailing address:
  • Phone: 781-769-4233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5091
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number5091
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number5091
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: