Provider Demographics
NPI:1134285067
Name:KREFFT, KATHERINE (PHD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:KREFFT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PACKARD ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-5665
Mailing Address - Country:US
Mailing Address - Phone:508-759-5461
Mailing Address - Fax:
Practice Address - Street 1:3193 CRANBERRY HWY
Practice Address - Street 2:
Practice Address - City:E WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-4707
Practice Address - Country:US
Practice Address - Phone:508-759-3843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6051103TC0700X
LA388103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100589OtherMBH MAGELLAN BEHL HEALTH
MAW04832OtherBLUE CROSS
MA0520918Medicaid
MA0520918Medicaid