Individual
KEVIN J WITHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
12 ALFRED ST, SUITE 200, WOBURN, MA 01801-1915
(781) 646-0500
(781) 646-7130
Mailing address
12 ALFRED ST, SUITE 200, WOBURN, MA 01801-1915
(781) 646-0500
(781) 646-7130
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
8413
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8413
LICENSE
MA
Enumeration date
01/22/2007
Last updated
07/08/2007
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