Provider Demographics
NPI:1205489952
Name:KITAKULE, FLAVIA
Entity type:Individual
Prefix:
First Name:FLAVIA
Middle Name:
Last Name:KITAKULE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 N WARREN ST APT 42
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4149
Mailing Address - Country:US
Mailing Address - Phone:857-266-9681
Mailing Address - Fax:
Practice Address - Street 1:233 NEEDHAM ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1573
Practice Address - Country:US
Practice Address - Phone:774-203-4671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health