Provider Demographics
NPI:1578765392
Name:COLVIN, MARY KATHRYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHRYN
Last Name:COLVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:COLVIN
Other - Last Name:PUTNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1 BOWDOIN SQ FL 7
Mailing Address - Street 2:PSYCHOLOGY ASSESSMENT CENTER, MGH
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2927
Mailing Address - Country:US
Mailing Address - Phone:617-724-2225
Mailing Address - Fax:617-724-3726
Practice Address - Street 1:1 BOWDOIN SQ FL 7
Practice Address - Street 2:PSYCHOLOGY ASSESSMENT CENTER, MGH
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2927
Practice Address - Country:US
Practice Address - Phone:617-724-2225
Practice Address - Fax:617-724-3726
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8892103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist