Provider Demographics
NPI:1225006042
Name:FLAGG, KATHERINE (PHD PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:FLAGG
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGIST
Other - Prefix:DR
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:FLAGG MCWHORTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:160 OLD DERBY ST.
Mailing Address - Street 2:SUITE 261
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-740-4847
Mailing Address - Fax:
Practice Address - Street 1:160 OLD DERBY ST.
Practice Address - Street 2:SUITE 261
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-740-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3399103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0514535Medicaid
W03431Medicare UPIN
MAWO3431Medicare ID - Type Unspecified