Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 8894 | MA |
Y | 103TC0700X | Clinical Psychologist | 8894 | MA |
NPI | 1013166743 |
---|---|
Provider Name | Katia Fredriksen |
First Address | Canton, MA 02021-2700 |
Second Address | Canton, MA 02021-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2008 |
Last Update Date | 18/09/2008 |