Healthcare Provider Details

I. General information

NPI: 1003214834
Provider Name (Legal Business Name): KYRA BATTAGLIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LINCOLN ST STE 2400
HINGHAM MA
02043-1579
US

IV. Provider business mailing address

350 LINCOLN ST STE 2400
HINGHAM MA
02043-1579
US

V. Phone/Fax

Practice location:
  • Phone: 508-812-7994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9081
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11728
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: