Healthcare Provider Details

I. General information

NPI: 1912814658
Provider Name (Legal Business Name): KIAH BERKELEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 CANAL ST
SALEM MA
01970-4673
US

IV. Provider business mailing address

8 WINDSOR LN
GLOUCESTER MA
01930-4062
US

V. Phone/Fax

Practice location:
  • Phone: 978-548-6288
  • Fax:
Mailing address:
  • Phone: 301-328-6012
  • 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: