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General NPI Number Information
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NPI Number | 1205140746
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Entity Type | Individual
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Provider Name | BENJAMIN KILLILEA PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 75 FENWOOD RD
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City | BOSTON
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State | MA
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Zip | 02115-6103
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Country | US
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Telephone | 617-626-9318
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Fax | 617-626-9531
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Provider Business Mailing Address
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Address Line | 39 BOTOLPH ST
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City | QUINCY
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State | MA
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Zip | 02171-1988
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Country | US
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Telephone | 339-987-0849
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 8993
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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