Provider Demographics
NPI:1396052940
Name:DELLAPORTA, KATHERINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:DELLAPORTA
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 1:395 MARLBOROUGH ST APT 9
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-1536
Mailing Address - Country:US
Mailing Address - Phone:585-704-4799
Mailing Address - Fax:
Practice Address - Street 1:121 MOUNT VERNON ST STE 22
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-1104
Practice Address - Country:US
Practice Address - Phone:585-704-4799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10092103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA713898OtherTUFTS HEALTH CARE
MA1307592Medicaid
MA98179101OtherNETWORK HEALTH
MA1000930OtherNHP
MA1000930OtherBMCHP
MA33-0538634OtherUNITED BEHAVIORAL HEALTH