MEDICARE: KAETHE WEINGARTEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1717	MA
2	103TC0700X	Clinical Psychologist	PSY 22545	CA

General Provider Information

NPI Number	:	1427334333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAETHE WEINGARTEN

Provider Business Mailing Address
First Line	:	82 HOMER ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02459-1517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	82 HOMER ST
Second Line	:
City	:	NEWTON
State	:	MA
Zip	:	02459-1517
Country	:	US
Telephone Number	:	617-964-7606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	10/25/2011

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Directions to “ KAETHE WEINGARTEN ” Practice Location

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