Provider Demographics
NPI:1154451177
Name:WEIR, KATRIN TODD
Entity Type:Individual
Prefix:DR
First Name:KATRIN
Middle Name:TODD
Last Name:WEIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATRIN
Other - Middle Name:
Other - Last Name:ROUSE WEIR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:4 HITCHING POST LN
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-1712
Mailing Address - Country:US
Mailing Address - Phone:413-599-1701
Mailing Address - Fax:413-543-2202
Practice Address - Street 1:529 MAIN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:INDIAN ORCHARD
Practice Address - State:MA
Practice Address - Zip Code:01151-1228
Practice Address - Country:US
Practice Address - Phone:413-543-5865
Practice Address - Fax:413-543-2202
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6803103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic