Provider Demographics
NPI:1386214542
Name:KYOYETERA, PRISCILLA BEATRICE
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:BEATRICE
Last Name:KYOYETERA
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 1:47 E GROVE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1816
Mailing Address - Country:US
Mailing Address - Phone:800-804-5041
Mailing Address - Fax:774-213-5479
Practice Address - Street 1:42 WASHINGTON ST STE 110
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1817
Practice Address - Country:US
Practice Address - Phone:800-804-5041
Practice Address - Fax:774-213-5479
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician