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General NPI Number Information
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NPI Number | 1134477243
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Entity Type | Individual
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Provider Name | KATHERINE LORRAINE WHITE LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 1290 TREMONT ST
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City | ROXBURY
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State | MA
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Zip | 02120-3432
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Country | US
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Telephone | 617-989-3080
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Fax |
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Provider Business Mailing Address
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Address Line | 16 WINFIELD ST APT #3
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City | SOUTH BOSTON
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State | MA
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Zip | 02127-4126
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Country | US
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Telephone | 786-546-7310
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9472
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License Number State | MA
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