Doctor Name: | MR. KEVIN JAMES MOYER-WILKES |
NPI Number: | 1851639488 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.ED., NCC |
License Number: | 463166 |
Business Practice Address: | 1 Elmwood Pl Boylston, MA - 015052040 |
Business Phone Number: | 5088690197 |
Business Fax Number: | 5088690313 |
Mailing Address: | 16 Saxon Rd, WORCESTER |
State: | MA |
Postal Code: | 016021522 |
Phone Number: | 5088690197 |
Fax Number: | 5088690313 |
NPI Enumeration Date: | 01/16/2013 |
NPI Last Update Date: | 01/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YS0200X |
License Number: | 463166 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | School |
Taxonomy Definition: |