Provider Demographics
NPI:1447604962
Name:DYETTE, KSERA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KSERA
Middle Name:
Last Name:DYETTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PATTEN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3933
Mailing Address - Country:US
Mailing Address - Phone:617-855-1243
Mailing Address - Fax:617-404-9342
Practice Address - Street 1:9 PATTEN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3933
Practice Address - Country:US
Practice Address - Phone:617-855-1243
Practice Address - Fax:617-404-9342
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily