Provider Demographics
NPI:1437620416
Name:KILIC, SEVDA
Entity Type:Individual
Prefix:
First Name:SEVDA
Middle Name:
Last Name:KILIC
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 1:66 MAIN ST APT 26A
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3350
Mailing Address - Country:US
Mailing Address - Phone:857-334-0941
Mailing Address - Fax:
Practice Address - Street 1:111 MAIN ST # 13R
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5890
Practice Address - Country:US
Practice Address - Phone:857-256-4919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician