Provider Demographics
NPI:1447561634
Name:KIZNER, PHYLLIS M
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:M
Last Name:KIZNER
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 1:11 CASTLE CIR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-4026
Mailing Address - Country:US
Mailing Address - Phone:978-532-4969
Mailing Address - Fax:978-531-2186
Practice Address - Street 1:11 CASTLE CIR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4026
Practice Address - Country:US
Practice Address - Phone:978-532-4969
Practice Address - Fax:978-531-2186
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)