Healthcare Provider Details

I. General information

NPI: 1992953418
Provider Name (Legal Business Name): KATHRYN KRAFT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

859 WILLARD ST STE 430
QUINCY MA
02169-7482
US

IV. Provider business mailing address

859 WILLARD ST STE 430
QUINCY MA
02169-7482
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 TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11796
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: