Provider Demographics
NPI:1639635717
Name:NELLIGAN, KIERA (LCSW)
Entity Type:Individual
Prefix:
First Name:KIERA
Middle Name:
Last Name:NELLIGAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6237
Mailing Address - Country:US
Mailing Address - Phone:617-922-4296
Mailing Address - Fax:
Practice Address - Street 1:20 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-2952
Practice Address - Country:US
Practice Address - Phone:718-715-2411
Practice Address - Fax:781-268-5070
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222479104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker