Provider Demographics
NPI:1578857348
Name:DENNIS, KIANESHA D
Entity Type:Individual
Prefix:
First Name:KIANESHA
Middle Name:D
Last Name:DENNIS
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 1:49 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2255
Mailing Address - Country:US
Mailing Address - Phone:781-864-1787
Mailing Address - Fax:
Practice Address - Street 1:49 COLLINS ST
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2255
Practice Address - Country:US
Practice Address - Phone:781-864-1787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor