Provider Demographics
NPI:1275297236
Name:ADAMS MONROE, KYRIAH KELSEY JAZAMINE
Entity Type:Individual
Prefix:
First Name:KYRIAH
Middle Name:KELSEY JAZAMINE
Last Name:ADAMS MONROE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BENTHAM RD APT 1
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-1604
Mailing Address - Country:US
Mailing Address - Phone:781-971-2866
Mailing Address - Fax:
Practice Address - Street 1:2 BENTHAM RD APT 1
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-1604
Practice Address - Country:US
Practice Address - Phone:781-971-2866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician