Healthcare Provider Details

I. General information

NPI: 1831855782
Provider Name (Legal Business Name): KELVIN KARANJA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 DWIGHT RD STE 103
LONGMEADOW MA
01106-1768
US

IV. Provider business mailing address

171 DWIGHT RD STE 103
LONGMEADOW MA
01106-1768
US

V. Phone/Fax

Practice location:
  • Phone: 413-200-0769
  • Fax: 877-421-3866
Mailing address:
  • Phone: 413-200-0769
  • Fax: 877-421-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2325507
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: