Healthcare Provider Details

I. General information

NPI: 1427662683
Provider Name (Legal Business Name): KIERSTYN MAO LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIERSTYN BRADY MA

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PELHAM RD STE 203
SALEM NH
03079-4851
US

IV. Provider business mailing address

26 PARKRIDGE RD STE 2B
HAVERHILL MA
01835-8515
US

V. Phone/Fax

Practice location:
  • Phone: 603-883-0005
  • Fax: 603-883-0007
Mailing address:
  • Phone: 978-373-3086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4888
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: