Provider Demographics
NPI:1083167720
Name:KAIROUZ, MARY ANN CYNTHIA
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:CYNTHIA
Last Name:KAIROUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY ANN
Other - Middle Name:CYNTHIA
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:83 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-1122
Mailing Address - Country:US
Mailing Address - Phone:617-955-1426
Mailing Address - Fax:
Practice Address - Street 1:31 LAKE ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3879
Practice Address - Country:US
Practice Address - Phone:978-632-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist