Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 10447 | MA |
NPI | 1023567161 |
---|---|
Provider Name | Kerry Mcgregor |
First Address | Boston, MA 02116-1753 |
Second Address | Boston, MA 02115-5711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2016 |
Last Update Date | 30/09/2016 |