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General NPI Number Information
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NPI Number | 1477621647
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Entity Type | Individual
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Provider Name | DIANNE KILTY KRAAIJVANGER PSYD, LMHC, LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 09/22/2023
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Provider Practice Location Address
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Address Line | 1 SOUTH AVE
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City | NATICK
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State | MA
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Zip | 01760-4600
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Country | US
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Telephone | 781-705-2797
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Fax |
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Provider Business Mailing Address
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Address Line | 1 SOUTH AVE
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City | NATICK
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State | MA
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Zip | 01760-4600
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Country | US
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Telephone | 781-705-2797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6124
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1308
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License Number State | MA
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