Provider Demographics
NPI:1891669305
Name:HICIANO, KEREN
Entity type:Individual
Prefix:
First Name:KEREN
Middle Name:
Last Name:HICIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PEABODY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5034
Mailing Address - Country:US
Mailing Address - Phone:781-513-8707
Mailing Address - Fax:
Practice Address - Street 1:22 PEABODY ST APT 1
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5034
Practice Address - Country:US
Practice Address - Phone:781-513-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty