Provider Demographics
NPI:1467724781
Name:STEVENSON, KAITLIN (LICSW)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-2685
Mailing Address - Country:US
Mailing Address - Phone:860-550-0966
Mailing Address - Fax:
Practice Address - Street 1:0 CRYSTAL ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-4003
Practice Address - Country:US
Practice Address - Phone:781-213-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1169741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical