MEDICARE: ELIZABETH KIA

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
1	1041C0700X	Clinical Social Worker	000225800	MA
2	1041C0700X	Clinical Social Worker	125434	MA

General Provider Information

NPI Number	:	1437772894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KIA

Provider Business Mailing Address
First Line	:	71 ALLEGHANY ST
Second Line	:
City	:	ROXBURY CROSSING
State	:	MA
Zip	:	02120-3338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 ALLEGHANY ST
Second Line	:
City	:	ROXBURY CROSSING
State	:	MA
Zip	:	02120-3338
Country	:	US
Telephone Number	:	617-254-0964
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	01/18/2024

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Directions to “ ELIZABETH KIA ” Practice Location

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