Provider Demographics
NPI:1740646843
Name:NINI, KAITLIN MARIE (MSSA, LCSW)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MARIE
Last Name:NINI
Suffix:
Gender:F
Credentials:MSSA, LCSW
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MARIE
Other - Last Name:CARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW, LMSW
Mailing Address - Street 1:15610 GRASSY WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46748-9117
Mailing Address - Country:US
Mailing Address - Phone:586-530-0735
Mailing Address - Fax:
Practice Address - Street 1:1027 W RUDISILL BLVD # 207
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-2160
Practice Address - Country:US
Practice Address - Phone:260-225-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34008811A104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker