Healthcare Provider Details

I. General information

NPI: 1730774704
Provider Name (Legal Business Name): OLEYETTA KAZAN PRIESTER MFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MAPLE ST STE 325
SPRINGFIELD MA
01103-2215
US

IV. Provider business mailing address

130 MAPLE ST STE 325
SPRINGFIELD MA
01103-2215
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-1314
  • Fax: 413-772-3749
Mailing address:
  • Phone: 413-773-1314
  • Fax: 413-772-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: