Provider Demographics
NPI:1477621647
Name:KRAAIJVANGER, DIANNE KILTY (PSYD, LMHC, LMFT)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:KILTY
Last Name:KRAAIJVANGER
Suffix:
Gender:F
Credentials:PSYD, LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4600
Mailing Address - Country:US
Mailing Address - Phone:781-705-2797
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4600
Practice Address - Country:US
Practice Address - Phone:781-705-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6124101YM0800X
MA1308106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health