Healthcare Provider Details

I. General information

NPI: 1700717469
Provider Name (Legal Business Name): KAMIL PIETRAS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TRADECENTER DRIVE SUITE 3680
WOBURN MA
01801
US

IV. Provider business mailing address

300 TRADECENTER DRIVE SUITE 3680
WOBURN MA
01801
US

V. Phone/Fax

Practice location:
  • Phone: 508-785-7282
  • Fax:
Mailing address:
  • Phone: 508-785-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2349053
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number080440-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: