Individual
ITOKO KIKUCHI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
415 NEPONSET AVE, FL 3, DORCHESTER, MA 02122
(857) 217-3700
Mailing address
415 NEPONSET AVE, FL 3, DORCHESTER, MA 02122
(857) 217-3700
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2292722
MA
Other
Enumeration date
12/02/2008
Last updated
12/26/2018
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