Healthcare Provider Details

I. General information

NPI: 1154482586
Provider Name (Legal Business Name): KIRTI AGARWAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAIN ST SUITE NO 383
WORCESTER MA
01608
US

IV. Provider business mailing address

340 MAIN ST SUITE NO 383
WORCESTER MA
01608
US

V. Phone/Fax

Practice location:
  • Phone: 508-791-4976
  • Fax: 508-791-6723
Mailing address:
  • Phone: 508-791-4976
  • Fax: 508-791-6723

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: