MEDICARE: MS. KATHRYN D RODDY NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2349801	MA
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	2349801	MA

General Provider Information

NPI Number	:	1861252835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN D RODDY NP

Provider Business Mailing Address
First Line	:	173 MOUNT AUBURN ST
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-4005
Country	:	US
Telephone Number	:	617-396-7434
Fax Number	:

Provider Business Practice Location Address
First Line	:	173 MOUNT AUBURN ST
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-4005
Country	:	US
Telephone Number	:	617-396-7434
Fax Number	:

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

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	01/22/2026

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