MEDICARE: ROBERTA DECKER KIGNER LICSW

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	1041C0700X	Clinical Social Worker	104986	MA

General Provider Information

NPI Number	:	1457456360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA DECKER KIGNER LICSW

Provider Business Mailing Address
First Line	:	43 OLD COLONY DRIVE
Second Line	:
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581
Country	:	US
Telephone Number	:	508-836-3943
Fax Number	:	508-872-0861

Provider Business Practice Location Address
First Line	:	45 LYMAN ST STE 19
Second Line	:
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-2658
Country	:	US
Telephone Number	:	508-330-4196
Fax Number	:	508-366-7270

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	03/01/2022

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