Provider Demographics
NPI:1518524123
Name:ATKINSON, KAYLEIGH KARIN
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:KARIN
Last Name:ATKINSON
Suffix:
Gender:F
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 SOUTHSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-1517
Mailing Address - Country:US
Mailing Address - Phone:781-816-3411
Mailing Address - Fax:
Practice Address - Street 1:278 MILL RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-4106
Practice Address - Country:US
Practice Address - Phone:888-922-2843
Practice Address - Fax:855-568-2490
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100219650106Medicaid