Provider Demographics
NPI:1962646125
Name:KENT, ERIN O'CONNOR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:O'CONNOR
Last Name:KENT
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 1:40 CRESCENT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-4313
Mailing Address - Country:US
Mailing Address - Phone:617-835-6533
Mailing Address - Fax:
Practice Address - Street 1:40 CRESCENT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-4313
Practice Address - Country:US
Practice Address - Phone:617-835-6533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9668103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist