Provider Demographics
NPI:1780018598
Name:CULVER, KYRRE DIKKEN (MA)
Entity Type:Individual
Prefix:
First Name:KYRRE
Middle Name:DIKKEN
Last Name:CULVER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 LIBERTY AVE # 1
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2022
Mailing Address - Country:US
Mailing Address - Phone:617-750-2409
Mailing Address - Fax:
Practice Address - Street 1:58 LIBERTY AVE # 1
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2022
Practice Address - Country:US
Practice Address - Phone:617-750-2409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)