Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | S79998791 | MA |
NPI | 1003257700 |
---|---|
Provider Name | Miss Daphney Kassiana Kersaint |
First Address | Randolph, MA 02368-3821 |
Second Address | Weymouth, MA 02190-1868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2013 |
Last Update Date | 10/07/2013 |