Basic Information
| Provider Information | |||||||||
| NPI: | 1225798770 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACGOVERN | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | ALEXANDRA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 149 POWER ST UNIT 2 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029062024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4015803145 | ||||||||
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| Practice Location | |||||||||
| Address1: | 66 TROY ST STE 4 | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027203023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086765708 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2021 | ||||||||
| LastUpdateDate: | 12/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.