Provider Demographics
NPI:1629551767
Name:ALBERTO, KAITLIN (LMFT)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:ALBERTO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 DEERING AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4857
Mailing Address - Country:US
Mailing Address - Phone:617-913-1795
Mailing Address - Fax:
Practice Address - Street 1:57 EXCHANGE ST STE 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5000
Practice Address - Country:US
Practice Address - Phone:617-913-1795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC5232101YP2500X
CA96718106H00000X
MEMF6572106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA96718OtherLICENSED MARRIAGE AND FAMILY THERAPIST