Healthcare Provider Details

I. General information

NPI: 1871742510
Provider Name (Legal Business Name): MRS. KIMMERLY M PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WARREN ST
BOSTON MA
02135-3602
US

IV. Provider business mailing address

30 WARREN ST
BOSTON MA
02135-3602
US

V. Phone/Fax

Practice location:
  • Phone: 617-635-8399
  • Fax:
Mailing address:
  • Phone: 617-635-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberS48924194
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: