Provider Demographics
NPI:1942061312
Name:CHRISTINE KAVESKI, LLC
Entity Type:Organization
Organization Name:CHRISTINE KAVESKI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVESKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:215-817-5672
Mailing Address - Street 1:867 BOYLSTON ST STE 500
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2774
Mailing Address - Country:US
Mailing Address - Phone:215-817-5672
Mailing Address - Fax:
Practice Address - Street 1:867 BOYLSTON ST STE 500
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2774
Practice Address - Country:US
Practice Address - Phone:215-817-5672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health