Healthcare Provider Details

I. General information

NPI: 1326573148
Provider Name (Legal Business Name): KATRINA LYNN OGDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2017
Last Update Date: 04/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VICTORY RD
QUINCY MA
02171-3139
US

IV. Provider business mailing address

500 VICTORY RD
QUINCY MA
02171-3139
US

V. Phone/Fax

Practice location:
  • Phone: 617-847-1950
  • Fax: 617-774-1490
Mailing address:
  • Phone: 617-847-1950
  • Fax: 617-774-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberS87863476
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: