Provider Demographics
NPI:1871752824
Name:REDDALL, KEVIN STEWART
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:STEWART
Last Name:REDDALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3131
Mailing Address - Country:US
Mailing Address - Phone:860-303-9670
Mailing Address - Fax:
Practice Address - Street 1:265 BEACH ST
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3131
Practice Address - Country:US
Practice Address - Phone:860-303-9670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical