Healthcare Provider Details

I. General information

NPI: 1083115174
Provider Name (Legal Business Name): VERONICA ELIBARIKI KUTTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 PLEASANT ST
LYNN MA
01901-1524
US

IV. Provider business mailing address

125 HARTWELL AVE
LEXINGTON MA
02421-3100
US

V. Phone/Fax

Practice location:
  • Phone: 718-581-4432
  • Fax:
Mailing address:
  • Phone: 781-861-0890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: