Kevin James Moyer-Wilkes, M.ED., NCC
Individual provider Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Boylston, MA
NPI 1851639488 · NPPES record last updated Jan 16, 2013
Key facts
- NPI
- 1851639488
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
- Practice address
- 1 Elmwood PL
Boylston, MA 01505-2040 - Phone
- (508) 869-0197
- Fax
- (508) 869-0313
- NPI assigned
- Jan 16, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C062011002701 | CT | MD | School Counselor |
| 463166 | MA | MD | School Counselor |
| 10606058 | PA | MD | School Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Counselor | 101YS0200X | 463166 | MA | |
| School Counselor | 101YS0200X | C062011002701 | CT | |
| School Counselor | 101YS0200X | 10606058 | PA | |
| Emotionally Disturbed Childrens' Residential Treatment Facility | 322D00000X | MA | Yes |
Addresses
Primary practice location
1 Elmwood PL
Boylston, MA 01505-2040
Mailing address
16 Saxon Rd
Worcester, MA 01602-1522
Phone (508) 869-0197
Other names
- Mr. Kevin James Wilkes
Other providers in Boylston, MA
- Jennifer Lee Konisky
- Kerry Lavallee
- Lynne Lavallee
- Lisa Munroe, DPT, PLLC
- Luz V Mercado
- Lisa Munroe
- Susan Ryan Palmer
- Karen Kiver Patalano
- Wayne M Pineau
- Professional Dental Allaince of Massachusetts PLLC
All providers in Boylston, MA · Emotionally Disturbed Childrens' Residential Treatment Facility in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.