Provider Demographics
NPI:1497527840
Name:DALE, KATHRYN ALLISON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ALLISON
Last Name:DALE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MOWER ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1519
Mailing Address - Country:US
Mailing Address - Phone:774-519-7795
Mailing Address - Fax:
Practice Address - Street 1:800 MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1888
Practice Address - Country:US
Practice Address - Phone:774-415-0003
Practice Address - Fax:774-415-0003
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA318748103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool