Healthcare Provider Details

I. General information

NPI: 1609928290
Provider Name (Legal Business Name): KRISTEN LEE KUCKER MED MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 12/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 WARREN ST
LOWELL MA
01852
US

IV. Provider business mailing address

4 AMALFI RD
METHUEN MA
01844-6348
US

V. Phone/Fax

Practice location:
  • Phone: 978-452-1736
  • Fax: 978-452-6625
Mailing address:
  • Phone: 978-258-1637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: