Provider Demographics
NPI:1104256619
Name:DAVIS, KATHRYN (MED)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:439 LINDSEY ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-1121
Mailing Address - Country:US
Mailing Address - Phone:774-254-4431
Mailing Address - Fax:
Practice Address - Street 1:160 GOULD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NEEDHAM HEIGHTS
Practice Address - State:MA
Practice Address - Zip Code:02494-2313
Practice Address - Country:US
Practice Address - Phone:781-559-4900
Practice Address - Fax:781-559-4900
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA471404101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor