Provider Demographics
NPI:1083365746
Name:BAIN, KATHLEEN ISABELLE (MA)
Entity Type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:ISABELLE
Last Name:BAIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:49 SAINT MARYS ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-8211
Mailing Address - Country:US
Mailing Address - Phone:518-683-5220
Mailing Address - Fax:
Practice Address - Street 1:1715 BROADWAY
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906-4703
Practice Address - Country:US
Practice Address - Phone:781-388-6256
Practice Address - Fax:617-387-9768
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health