Provider Demographics
NPI:1295250843
Name:KAISER, PINAR (PSYD)
Entity type:Individual
Prefix:
First Name:PINAR
Middle Name:
Last Name:KAISER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AMY ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3802
Mailing Address - Country:US
Mailing Address - Phone:201-841-0381
Mailing Address - Fax:
Practice Address - Street 1:234 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1947
Practice Address - Country:US
Practice Address - Phone:508-852-1805
Practice Address - Fax:508-595-1130
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11305103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical