MEDICARE: KAYA PSYCHOTHERAPY PLLC

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

General Provider Information

NPI Number	:	1518647957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAYA PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	6 SUNSET DR
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-2320
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 SUNSET DR
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-2320
Country	:	US
Telephone Number	:	978-219-7111
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. RAIZA ALYSSA FELICITAS
Credential	:	LICSW
Telephone Number	:	978-219-7111

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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