Healthcare Provider Details

I. General information

NPI: 1982524252
Provider Name (Legal Business Name): KENDRIS MILAGROS DE LEON CEBALLOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 STATE ST
SPRINGFIELD MA
01109-4104
US

IV. Provider business mailing address

576 STATE ST
SPRINGFIELD MA
01109-4104
US

V. Phone/Fax

Practice location:
  • Phone: 413-949-3644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: