Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 5091 | MA |
Y | 103TC0700X | Clinical Psychologist | 5091 | MA |
N | 102L00000X | Psychologist | 5091 | MA |
N | 103T00000X | Psychologist | 5091 | MA |
N | 103TH0100X | Health Service | 5091 | MA |
NPI | 1124044375 |
---|---|
Provider Name | Dr. Katherine Mary Kalliel |
First Address | Norwood, MA 02062-2320 |
Second Address | Norwood, MA 02062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 10/07/2019 |