MEDICARE: DR. KSERA DYETTE PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist
2	103TC0700X	Clinical Psychologist	10984	MA
3	103T00000X	Psychologist

General Provider Information

NPI Number	:	1447604962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KSERA DYETTE PSY.D.

Provider Business Mailing Address
First Line	:	163 HIGHLAND AVE # 1089
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3025
Country	:	US
Telephone Number	:	617-855-1243
Fax Number	:

Provider Business Practice Location Address
First Line	:	163 HIGHLAND AVE # 1089
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3025
Country	:	US
Telephone Number	:	617-855-1243
Fax Number	:	617-404-9342

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	11/10/2025

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