Healthcare Provider Details

I. General information

NPI: 1790840932
Provider Name (Legal Business Name): DEBRA KLEZMER LMT,RN,C,CRRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 DIAUTO DR
RANDOLPH MA
02368-6202
US

IV. Provider business mailing address

42 DIAUTO DR
RANDOLPH MA
02368-4510
US

V. Phone/Fax

Practice location:
  • Phone: 781-986-6443
  • Fax: 781-986-4837
Mailing address:
  • Phone: 781-986-6443
  • Fax: 781-986-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number145673
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number079
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: