Provider Demographics
NPI:1558136580
Name:KAKADIY, COLLEEN
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:KAKADIY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:MEAGHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:833 BENNETT WAY
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-2352
Mailing Address - Country:US
Mailing Address - Phone:978-790-3580
Mailing Address - Fax:
Practice Address - Street 1:833 BENNETT WAY
Practice Address - Street 2:
Practice Address - City:NEWMARKET
Practice Address - State:NH
Practice Address - Zip Code:03857-2352
Practice Address - Country:US
Practice Address - Phone:978-790-3580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1-19-37421103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst