Provider Demographics
NPI:1013779354
Name:HENRY, KATHERINE RUTH (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:RUTH
Last Name:HENRY
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 1:260 FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2170
Mailing Address - Country:US
Mailing Address - Phone:781-620-2142
Mailing Address - Fax:
Practice Address - Street 1:260 FORDHAM RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-2170
Practice Address - Country:US
Practice Address - Phone:781-620-2142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA519803103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool