Healthcare Provider Details

I. General information

NPI: 1346333606
Provider Name (Legal Business Name): MARLENE SUSAN KATZ APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 BEACON ST
WABAN MA
02468-1432
US

IV. Provider business mailing address

1865 BEACON ST
WABAN MA
02468-1432
US

V. Phone/Fax

Practice location:
  • Phone: 617-965-9035
  • Fax: 617-965-9035
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number94409
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: