Provider Demographics
NPI:1285118760
Name:KIZIRIAN, AMY (LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KIZIRIAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1387
Mailing Address - Country:US
Mailing Address - Phone:339-227-2555
Mailing Address - Fax:
Practice Address - Street 1:186 HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1387
Practice Address - Country:US
Practice Address - Phone:339-227-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor