Provider Demographics
NPI:1861627317
Name:KATHLEEN L. NELSON, M.D., L.L.C., ADULT PSYCHIATRY
Entity Type:Organization
Organization Name:KATHLEEN L. NELSON, M.D., L.L.C., ADULT PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-338-5680
Mailing Address - Street 1:100 CUMMINGS CTR
Mailing Address - Street 2:SUITE 343F
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6115
Mailing Address - Country:US
Mailing Address - Phone:978-338-5680
Mailing Address - Fax:978-338-5681
Practice Address - Street 1:100 CUMMINGS CTR
Practice Address - Street 2:SUITE 343F
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6115
Practice Address - Country:US
Practice Address - Phone:978-338-5680
Practice Address - Fax:978-338-5681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78498261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1861627317OtherBLUE CROSS/BLUE SHIELD
MA1861627317OtherCIGNA
MA1861627317OtherHARVARD PILGRIM
MA1861627317OtherTUFTS
MA1861627317OtherCIGNA