Provider Demographics
NPI:1376115493
Name:NAZAIRE, KEYNESSA
Entity Type:Individual
Prefix:
First Name:KEYNESSA
Middle Name:
Last Name:NAZAIRE
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 CHERYL LN
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1219
Mailing Address - Country:US
Mailing Address - Phone:617-412-6344
Mailing Address - Fax:
Practice Address - Street 1:200 CORDWAINER DR STE 202
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1671
Practice Address - Country:US
Practice Address - Phone:781-871-0306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor