Provider Demographics
NPI:1669020962
Name:KUMAR, DIVYA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIVYA
Middle Name:
Last Name:KUMAR
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 1:48 SEAVERNS AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2867
Mailing Address - Country:US
Mailing Address - Phone:617-610-5272
Mailing Address - Fax:
Practice Address - Street 1:4238 WASHINGTON ST # 316
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2558
Practice Address - Country:US
Practice Address - Phone:857-273-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0002249721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherDON'T HAVE THESE NUMBERS