Provider Demographics
NPI:1962195719
Name:NIMELY, KANFEE SIRYON
Entity type:Individual
Prefix:
First Name:KANFEE
Middle Name:SIRYON
Last Name:NIMELY
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 1:1905 MIDDLESEX ST APT 15
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-1005
Mailing Address - Country:US
Mailing Address - Phone:197-601-6076
Mailing Address - Fax:
Practice Address - Street 1:1905 MIDDLESEX ST APT 15
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1005
Practice Address - Country:US
Practice Address - Phone:197-601-6076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health