Active NPI
Kayla Revallion
- Case Manager/Care Coordinator
- Cambridge, MA
National Provider Identifier
1619351590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- License
- S16482656
- Practice address
- 21 Valentine St
6
Cambridge, MA 02139-4073 - Phone
- (617) 875-6571
- NPI assigned
- Jul 10, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | S16482656 | MA | Primary |
Addresses
Primary practice location
21 Valentine St
6
Cambridge, MA 02139-4073
Mailing address
21 Valentine St
6
Cambridge, MA 02139-4073
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S16482656 | MA | MD | Case Manager/Care Coordinator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1436486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436486400000",
"number": "1619351590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 VALENTINE ST",
"address_2": "6",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021394073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 VALENTINE ST",
"address_2": "6",
"city": "CAMBRIDGE",
"state": "MA",
"postal_code": "021394073",
"telephone_number": "617-875-6571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REVALLION",
"first_name": "KAYLA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-10",
"last_updated": "2015-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "MA",
"license": "S16482656",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.