Healthcare Provider Details

I. General information

NPI: 1245500180
Provider Name (Legal Business Name): MS. KRISTEN ROSS CAHILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 CENTRAL ST
WALTHAM MA
02453-5465
US

IV. Provider business mailing address

118 CENTRAL STREET WAYSIDE YOUTH & FAMILY SUPPORT NETWORK
WALTHAM MA
02453
US

V. Phone/Fax

Practice location:
  • Phone: 617-820-3803
  • Fax:
Mailing address:
  • Phone: 617-820-3803
  • 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: