Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 101YM0800X | Mental Health Counselor | ||
N | 101YP2500X | Professional Counselor | ||
N | 101YS0200X | School Counselor | ||
N | 104100000X | Social Worker | ||
N | 1041C0700X | Clinical Social Worker | ||
N | 1041S0200X | School Social Worker |
NPI | 1083167720 |
---|---|
Provider Name | Mary Ann Cynthia Kairouz |
First Address | Orange, MA 01364-1122 |
Second Address | Gardner, MA 01440-3879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2016 |
Last Update Date | 29/07/2016 |