Healthcare Provider Details

I. General information

NPI: 1073075982
Provider Name (Legal Business Name): CUP OF TEA COUNSELLING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 HIGHLAND AVE # 1089
NEEDHAM MA
02494-3025
US

IV. Provider business mailing address

163 HIGHLAND AVE # 1089
NEEDHAM MA
02494-3025
US

V. Phone/Fax

Practice location:
  • Phone: 617-855-1243
  • Fax:
Mailing address:
  • Phone: 617-855-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KSERA DYETTE
Title or Position: OWNER
Credential: PSYD
Phone: 617-855-1243