Provider Demographics
NPI:1194365312
Name:KITCHENER, ERIN GRACE (PHD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:GRACE
Last Name:KITCHENER
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 1:118 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2802
Mailing Address - Country:US
Mailing Address - Phone:858-334-8674
Mailing Address - Fax:
Practice Address - Street 1:1 WELLS AVE FL 4
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3211
Practice Address - Country:US
Practice Address - Phone:617-323-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11231103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist