Provider Demographics
NPI:1154130052
Name:KENISTON, JOHN PARKER
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PARKER
Last Name:KENISTON
Suffix:
Gender:U
Credentials:
Other - Prefix:
Other - First Name:PARKER
Other - Middle Name:J
Other - Last Name:KENISTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7 LOWELL CIR
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2409
Mailing Address - Country:US
Mailing Address - Phone:207-360-1418
Mailing Address - Fax:
Practice Address - Street 1:17 INNERBELT RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-4418
Practice Address - Country:US
Practice Address - Phone:857-208-0997
Practice Address - Fax:617-629-0010
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health