Provider Demographics
NPI:1023181021
Name:YAMARTINO, KATHRYN (EDM, PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:YAMARTINO
Suffix:
Gender:F
Credentials:EDM, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5885
Mailing Address - Country:US
Mailing Address - Phone:978-264-4003
Mailing Address - Fax:978-264-4003
Practice Address - Street 1:930 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5885
Practice Address - Country:US
Practice Address - Phone:978-264-4003
Practice Address - Fax:978-264-4003
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7750103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW055594OtherBLUE CROSS BLUE SHIELD