Provider Demographics
NPI:1407334170
Name:KANGEE-CARD, MIATTA (CAGS, NCSP, LEP)
Entity Type:Individual
Prefix:
First Name:MIATTA
Middle Name:
Last Name:KANGEE-CARD
Suffix:
Gender:F
Credentials:CAGS, NCSP, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-6084
Mailing Address - Country:US
Mailing Address - Phone:617-501-6511
Mailing Address - Fax:
Practice Address - Street 1:399 BOYLSTON ST STE 900
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3305
Practice Address - Country:US
Practice Address - Phone:617-207-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1193103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist