Individual
KEVIN JOSEPH ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
520 DUDLEY ST, ROXBURY, MA 02119-2769
(508) 208-4656
Mailing address
520 DUDLEY ST, ROXBURY, MA 02119-2769
(617) 445-6655
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
S40107772
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000023532
BMC
MA
01
—
042611055
TAX ID
MA
01
—
1004745
NHP
MA
01
—
1303287
MBHP
MA
05
—
1303287
—
MA
01
—
99618201
NETWORTH HEALTH
MA
01
—
M18633
BCBS
MA
Enumeration date
09/30/2013
Last updated
11/15/2013
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