Provider Demographics
NPI:1205434479
Name:DOLSON-OSTRANDER, KIAMESHA (LMSW)
Entity type:Individual
Prefix:
First Name:KIAMESHA
Middle Name:
Last Name:DOLSON-OSTRANDER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 SOUTHWICK RD APT 90
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4793
Mailing Address - Country:US
Mailing Address - Phone:845-728-3267
Mailing Address - Fax:
Practice Address - Street 1:14 PAGE TER STE 2A
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-4602
Practice Address - Country:US
Practice Address - Phone:866-871-9807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101807-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty