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NPI Code Detail

MEDICARE: KATY WIXSOM

MEDICARE: KATY WIXSOM
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1437564093
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATY WIXSOM
Provider Business Mailing Address
First Line : 359 FENN ST
Second Line : ADMINISTRATIVE OFFICES
City : PITTSFIELD
State : MA
Zip : 01201-5261
Country : US
Telephone Number : 413-629-1251
Fax Number : 413-448-2198
Provider Business Practice Location Address
First Line : 359 FENN ST
Second Line : ADMINISTRATIVE OFFICES
City : PITTSFIELD
State : MA
Zip : 01201-5261
Country : US
Telephone Number : 413-629-1251
Fax Number : 413-448-2198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2014
Last Update Date : 06/04/2026

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Directions to “ KATY WIXSOM ” Practice Location

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