Provider Demographics
NPI:1174173785
Name:BEKKELI, KAI LE PAGE
Entity type:Individual
Prefix:
First Name:KAI
Middle Name:LE PAGE
Last Name:BEKKELI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 FARNUM ST # 1
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5704
Mailing Address - Country:US
Mailing Address - Phone:617-415-8715
Mailing Address - Fax:
Practice Address - Street 1:251 HARVARD ST STE 8
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5000
Practice Address - Country:US
Practice Address - Phone:617-415-8715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical