Healthcare Provider Details

I. General information

NPI: 1710975644
Provider Name (Legal Business Name): KIRA A DIES SCM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRA A APSE LGC

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE CLS 14074
BOSTON MA
02115-5724
US

IV. Provider business mailing address

94 W SPRINGFIELD ST UNIT 1
BOSTON MA
02118-3303
US

V. Phone/Fax

Practice location:
  • Phone: 617-919-3009
  • Fax: 617-919-2769
Mailing address:
  • Phone: 617-290-6657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: