Provider Demographics
NPI:1639331986
Name:SMITH, KAITLIN
Entity Type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:
Last Name:SMITH
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 1:63 CAREY AVE
Mailing Address - Street 2:APT 5
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-3071
Mailing Address - Country:US
Mailing Address - Phone:631-943-5389
Mailing Address - Fax:
Practice Address - Street 1:63 CAREY AVE
Practice Address - Street 2:APT 5
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-3071
Practice Address - Country:US
Practice Address - Phone:631-943-5389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical