Provider Demographics
NPI:1851676654
Name:KIEVAL, NATHANIEL EZRA (MS,ED)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:EZRA
Last Name:KIEVAL
Suffix:
Gender:M
Credentials:MS,ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 RUTLAND ST
Mailing Address - Street 2:1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1525
Mailing Address - Country:US
Mailing Address - Phone:561-310-2320
Mailing Address - Fax:
Practice Address - Street 1:288 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-1820
Practice Address - Country:US
Practice Address - Phone:781-447-6425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health