Provider Demographics
NPI:1194531541
Name:KYASA, NAHLA
Entity type:Individual
Prefix:
First Name:NAHLA
Middle Name:
Last Name:KYASA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NIBLICK RD
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-7724
Mailing Address - Country:US
Mailing Address - Phone:312-316-0410
Mailing Address - Fax:
Practice Address - Street 1:44 BEARFOOT RD STE 300
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1563
Practice Address - Country:US
Practice Address - Phone:312-316-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MALCSW21208131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical