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NPI Code Detail

MEDICARE: MR. KEVIN A HALL LICSW

MEDICARE: MR. KEVIN A HALL LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor1021510MA
21041C0700XClinical Social WorkerISW01293RI

General Provider Information

NPI Number : 1376874925
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN A HALL LICSW
Provider Business Mailing Address
First Line : 205 PORTLAND ST
Second Line :
City : BOSTON
State : MA
Zip : 02114-1721
Country : US
Telephone Number : 617-523-2214
Fax Number :
Provider Business Practice Location Address
First Line : 205 PORTLAND ST
Second Line :
City : BOSTON
State : MA
Zip : 02114-1721
Country : US
Telephone Number : 617-523-2214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2010
Last Update Date : 12/20/2010

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Directions to “ MR. KEVIN A HALL LICSW” Practice Location

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