Provider Demographics
NPI:1568298701
Name:CORRIVEAU, KEAIRA MORGAN-LEE
Entity type:Individual
Prefix:MS
First Name:KEAIRA
Middle Name:MORGAN-LEE
Last Name:CORRIVEAU
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 1:199 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085
Mailing Address - Country:US
Mailing Address - Phone:413-992-9213
Mailing Address - Fax:
Practice Address - Street 1:199 PLUM ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085
Practice Address - Country:US
Practice Address - Phone:413-992-9213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician