Provider Demographics
NPI:1750779005
Name:CRAIGEN, KATHERINE L E (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:L E
Last Name:CRAIGEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ROCKDALE HILL CIR
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1722
Mailing Address - Country:US
Mailing Address - Phone:603-738-3722
Mailing Address - Fax:
Practice Address - Street 1:69 HICKORY DR STE 2000
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-1011
Practice Address - Country:US
Practice Address - Phone:781-269-2823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020950103TC0700X
CT003865103TC0700X
MA10151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical