Provider Demographics
NPI:1285298398
Name:DIRKS, KATY MCGARTY (LMHC)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:MCGARTY
Last Name:DIRKS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 HILLSIDE AVE
Mailing Address - Street 2:PLUMSTREET
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1278
Mailing Address - Country:US
Mailing Address - Phone:617-947-7837
Mailing Address - Fax:
Practice Address - Street 1:475 HILLSIDE AVE
Practice Address - Street 2:PLUMSTREET
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1278
Practice Address - Country:US
Practice Address - Phone:617-947-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health