Provider Demographics
NPI:1225579949
Name:BASTIEN, KERLINE (MSW)
Entity Type:Individual
Prefix:
First Name:KERLINE
Middle Name:
Last Name:BASTIEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 AMERICAN LEGION HWY #2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-1501
Mailing Address - Country:US
Mailing Address - Phone:617-308-4257
Mailing Address - Fax:
Practice Address - Street 1:36 AMERICAN LEGION HWY #2
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-1501
Practice Address - Country:US
Practice Address - Phone:617-308-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical