Provider Demographics
NPI:1386236677
Name:MOSCHANDREAS, KATHERINE ELENEE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELENEE
Last Name:MOSCHANDREAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HEDGE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7551
Mailing Address - Country:US
Mailing Address - Phone:510-541-4214
Mailing Address - Fax:
Practice Address - Street 1:60 HEDGE RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7551
Practice Address - Country:US
Practice Address - Phone:510-541-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty