Provider Demographics
NPI:1285085159
Name:LOU, KATHERINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:LOU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8709 BRAY VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1713
Mailing Address - Country:US
Mailing Address - Phone:617-366-2550
Mailing Address - Fax:617-340-3733
Practice Address - Street 1:75 ARLINGTON ST FL 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3936
Practice Address - Country:US
Practice Address - Phone:617-366-2550
Practice Address - Fax:617-340-3733
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10493103TA0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110119105AMedicaid