Provider Demographics
NPI:1912142902
Name:KING, KATHERINE D
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:D
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 FURNACE BROOK PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4789
Mailing Address - Country:US
Mailing Address - Phone:857-288-8508
Mailing Address - Fax:888-262-9456
Practice Address - Street 1:1266 FURNACE BROOK PKWY STE 307
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4789
Practice Address - Country:US
Practice Address - Phone:857-288-8508
Practice Address - Fax:888-262-9456
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA9599103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program