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General NPI Number Information
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NPI Number | 1710477989
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Entity Type | Individual
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Provider Name | KERRI WEISE AUGUSTO PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/14/2018
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Last Update Date | 05/14/2018
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Provider Practice Location Address
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Address Line | 964 MAIN ST
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City | LEICESTER
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State | MA
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Zip | 01524-1310
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Country | US
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Telephone | 508-373-9772
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Fax |
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Provider Business Mailing Address
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Address Line | 131 JEFFERSON AVE
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City | NORTHBRIDGE
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State | MA
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Zip | 01534-1073
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Country | US
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Telephone | 508-314-5329
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 7251
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License Number State | MA
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