Provider Demographics
NPI:1720539182
Name:KAMUENE, VIRGINIE KASIAMA (IHT/BA ICC, FP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIE
Middle Name:KASIAMA
Last Name:KAMUENE
Suffix:
Gender:F
Credentials:IHT/BA ICC, FP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 UNION STREET
Mailing Address - Street 2:200
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01845
Mailing Address - Country:US
Mailing Address - Phone:978-289-7258
Mailing Address - Fax:
Practice Address - Street 1:15 UNION ST
Practice Address - Street 2:200
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1866
Practice Address - Country:US
Practice Address - Phone:978-289-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA101YM0800XMedicaid