Individual
ILANA KITTRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
109 OAK ST STE G20, NEWTON, MA 02464-1492
(617) 658-5611
Mailing address
109 OAK ST STE G20, NEWTON, MA 02464-1492
(617) 658-5611
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110026265E
—
MA
Enumeration date
06/25/2019
Last updated
05/02/2022
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