Provider Demographics
NPI:1639549413
Name:KANNO, YUKA
Entity Type:Individual
Prefix:
First Name:YUKA
Middle Name:
Last Name:KANNO
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 1:85 E NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2841
Mailing Address - Country:US
Mailing Address - Phone:617-305-9975
Mailing Address - Fax:617-305-9992
Practice Address - Street 1:85 E NEWTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2841
Practice Address - Country:US
Practice Address - Phone:617-305-9975
Practice Address - Fax:617-305-9992
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health