Provider Demographics
NPI:1679984017
Name:BYRON, KATHLEEN SPEHAR (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:SPEHAR
Last Name:BYRON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-3305
Mailing Address - Country:US
Mailing Address - Phone:617-288-0970
Mailing Address - Fax:
Practice Address - Street 1:1140 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-3305
Practice Address - Country:US
Practice Address - Phone:617-288-0970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA313651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker