Individual ProviderKevin Joseph AndersonCounselorBehavioral Health & Social Service ProvidersPractice Address520 Dudley St, Roxbury, MA 02119-2769(508) 208-4656(617) 445-6655PECOS EnrollmentBased on the most recent information from CMS, provider Kevin Joseph Anderson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1134556624Provider TypeIndividualFull NameAnderson, Kevin JosephGenderMaleSole ProprietorYesEnumeration Date9/30/2013Last Updated11/15/2013Contact InformationPractice LocationPractice Address520 Dudley St, Roxbury, MA 02119-2769Phone(508) 208-4656FaxUnlisted FaxMailing LocationMailing Address520 Dudley St, Roxbury, MA 02119-2769Phone(617) 445-6655FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101Y00000XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseS40107772MassachusettsProvider IdentifiersIDDescriptionIssuerID0000023532DescriptionOtherIssuerBMCMassachusettsID042611055DescriptionOtherIssuerTAX IDMassachusettsID1303287DescriptionMedicaidIssuerUnlistedMassachusettsID99618201DescriptionOtherIssuerNETWORTH HEALTHMassachusettsIDM18633DescriptionOtherIssuerBCBSMassachusettsID1004745DescriptionOtherIssuerNHPMassachusettsID1303287DescriptionOtherIssuerMBHPMassachusetts