Provider Demographics
NPI:1952198905
Name:CRAIG, KYLE JOHN
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:JOHN
Last Name:CRAIG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 WILLARD ST APT 186
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6122
Mailing Address - Country:US
Mailing Address - Phone:617-704-2391
Mailing Address - Fax:
Practice Address - Street 1:73 BELMONT ST
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1103
Practice Address - Country:US
Practice Address - Phone:617-691-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health