Provider Demographics
NPI:1710611710
Name:HASKELL, KAITLYNN PAIGE
Entity Type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:PAIGE
Last Name:HASKELL
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 1:139 W MAIN ST APT A7
Mailing Address - Street 2:
Mailing Address - City:WEST BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01585-2872
Mailing Address - Country:US
Mailing Address - Phone:847-814-4789
Mailing Address - Fax:
Practice Address - Street 1:179 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1057
Practice Address - Country:US
Practice Address - Phone:413-529-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health