Healthcare Provider Details

I. General information

NPI: 1356254544
Provider Name (Legal Business Name): MISS KATHRYN TUESDAY KRESOWATY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 FRONT ST APT 2
FALL RIVER MA
02721-4302
US

IV. Provider business mailing address

132 VALE ST APT 9
FALL RIVER MA
02724-3257
US

V. Phone/Fax

Practice location:
  • Phone: 508-676-1307
  • Fax:
Mailing address:
  • Phone: 508-415-9332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: