Provider Demographics
NPI:1558845370
Name:CASALETTO, KAITLIN BLACKSTONE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:BLACKSTONE
Last Name:CASALETTO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:BLACKSTONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:675 NELSON RISING LN STE 190
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0003
Mailing Address - Country:US
Mailing Address - Phone:415-476-1883
Mailing Address - Fax:
Practice Address - Street 1:675 NELSON RISING LN STE 190
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0003
Practice Address - Country:US
Practice Address - Phone:415-476-1883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical