Provider Demographics
NPI:1629387162
Name:GEREMIA, KATHRYN (MA PSYD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:GEREMIA
Suffix:
Gender:F
Credentials:MA PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W PARK DR STE 280
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3919
Mailing Address - Country:US
Mailing Address - Phone:508-713-1640
Mailing Address - Fax:
Practice Address - Street 1:1900 W PARK DR STE 280
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-3919
Practice Address - Country:US
Practice Address - Phone:508-713-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical