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General NPI Number Information
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NPI Number | 1255677969
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Entity Type | Individual
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Provider Name | KAILA NORMAN MACK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/27/2012
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 165 MIDDLESEX AVE STE 1118
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City | SOMERVILLE
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State | MA
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Zip | 02145-1105
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Country | US
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Telephone | 617-934-0219
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 701 BOX 371
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City | APO
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State | AP
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Zip | 96555-0004
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Country | US
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Telephone | 617-934-0219
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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 | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 10244
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License Number State | MA
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