Healthcare Provider Details

I. General information

NPI: 1194907063
Provider Name (Legal Business Name): BETH KUO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH DEFRINO

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 ACCESS RD SUITE 24
NORWOOD MA
02062-5229
US

IV. Provider business mailing address

89 ACCESS RD SUITE 24
NORWOOD MA
02062-5229
US

V. Phone/Fax

Practice location:
  • Phone: 781-551-0999
  • Fax: 781-551-3396
Mailing address:
  • Phone: 781-551-0999
  • Fax: 781-551-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8803
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: