Healthcare Provider Details

I. General information

NPI: 1427968643
Provider Name (Legal Business Name): KEVIN MARK PRESTON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 BROOK ST
RAYNHAM MA
02767-1193
US

IV. Provider business mailing address

61 BROOK ST
RAYNHAM MA
02767-1193
US

V. Phone/Fax

Practice location:
  • Phone: 617-222-0434
  • Fax:
Mailing address:
  • Phone: 617-222-0434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2143393
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: