Healthcare Provider Details

I. General information

NPI: 1619882933
Provider Name (Legal Business Name): KERRY GUEST PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GUEST ST APT 514
BOSTON MA
02135-2071
US

IV. Provider business mailing address

301 GUEST ST APT 514 APT 514
ALLSTON MA
02134-2089
US

V. Phone/Fax

Practice location:
  • Phone: 314-624-5711
  • Fax:
Mailing address:
  • Phone: 314-624-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number006035
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: