MEDICARE: MRS. CHRISTY KIERNAN 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	1041S0200X	School Social Worker	113533	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113533	OTHER	MA	LICSW

General Provider Information

NPI Number	:	1821686049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTY KIERNAN LICSW

Provider Business Mailing Address
First Line	:	85 FRANKLIN ST
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-3213
Country	:	US
Telephone Number	:	617-818-2401
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 MEDFORD ST
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-3121
Country	:	US
Telephone Number	:	781-777-7014
Fax Number	:

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

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	01/04/2021

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