Basic Information
| Provider Information | |||||||||
| NPI: | 1821198227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KUGLER | ||||||||
| FirstName: | LOIS | ||||||||
| MiddleName: | ROSENBERG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 CROSBY LANE | ||||||||
| Address2: | |||||||||
| City: | BREWSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088962602 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 310 BARNSTABLE ROAD | ||||||||
| Address2: | |||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088620514 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 7157 | MA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC2200X | 7157 | MA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0000X | 7157 | MA | X | Behavioral Health & Social Service Providers | Psychologist | Family |
ID Information
| ID | Type | State | Issuer | Description | 175080 | 01 | MHN/CHAMPUS | OTHER | W50450 | 01 | MA | FALLON COMMUNITY HEALTH | OTHER | W06001 | 01 | MA | BC/BS | OTHER |