Provider Demographics
NPI:1801277512
Name:ROBERTS, KATHERINE TIERNEY (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:TIERNEY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:TIERNEY
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:MASSACHUSETTS GENERAL HOSPITAL
Mailing Address - Street 2:55 FRUIT ST.
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-726-2066
Mailing Address - Fax:
Practice Address - Street 1:9 ASHLEA DR
Practice Address - Street 2:
Practice Address - City:GLENMOORE
Practice Address - State:PA
Practice Address - Zip Code:19343
Practice Address - Country:US
Practice Address - Phone:804-687-9656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty