Doctor Name: | KEVIN JOSEPH ANDERSON |
NPI Number: | 1134556624 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | S40107772 |
Business Practice Address: | 520 Dudley St Roxbury, MA - 021192769 |
Business Phone Number: | 5082084656 |
Business Fax Number: | |
Mailing Address: | 520 Dudley St, ROXBURY |
State: | MA |
Postal Code: | 021192769 |
Phone Number: | 6174456655 |
Fax Number: | |
NPI Enumeration Date: | 09/30/2013 |
NPI Last Update Date: | 11/15/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | S40107772 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |