Provider Demographics
NPI:1063035566
Name:MUSKAT, HERMINE (EDD)
Entity Type:Individual
Prefix:
First Name:HERMINE
Middle Name:
Last Name:MUSKAT
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 WASHINGTON ST APT 521
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2170
Mailing Address - Country:US
Mailing Address - Phone:617-877-5722
Mailing Address - Fax:
Practice Address - Street 1:1313 WASHINGTON ST APT 521
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2170
Practice Address - Country:US
Practice Address - Phone:617-877-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1597103TA0700X
103TB0200X
MA1597-PY-PR103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA115923574Other1597-PY-PR