Provider Demographics
NPI:1083334510
Name:WHITE, KAITLIN ELAINE (PSYD, MA, MED)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ELAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PSYD, MA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E 4TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-3227
Mailing Address - Country:US
Mailing Address - Phone:857-208-9031
Mailing Address - Fax:
Practice Address - Street 1:591 NORTH AVENUE
Practice Address - Street 2:DOOR #3, FIRST FLOOR
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-287-9506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program