Provider Demographics
NPI:1538110721
Name:LESSES, EVE KITCHEN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:EVE
Middle Name:KITCHEN
Last Name:LESSES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GRAY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1510
Mailing Address - Country:US
Mailing Address - Phone:617-354-4690
Mailing Address - Fax:617-492-6475
Practice Address - Street 1:18 GRAY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1510
Practice Address - Country:US
Practice Address - Phone:617-354-4690
Practice Address - Fax:617-492-6475
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1117681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23260Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID #