Provider Demographics
NPI:1245515618
Name:KAFINA, THERESA (NP)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:KAFINA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RESERVOIR ST STE 21
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-3133
Mailing Address - Country:US
Mailing Address - Phone:781-429-7755
Mailing Address - Fax:
Practice Address - Street 1:220 RESERVOIR ST STE 21
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-3133
Practice Address - Country:US
Practice Address - Phone:781-429-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN199157363LA2200X
MARN119157363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health