Provider Demographics
NPI:1760097448
Name:HATFIELD, KAITLIN BLUM (LPC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:BLUM
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 N HANCOCK ST APT H430
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-1889
Mailing Address - Country:US
Mailing Address - Phone:711-724-7052
Mailing Address - Fax:
Practice Address - Street 1:22 S 40TH ST STE 201B
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5827
Practice Address - Country:US
Practice Address - Phone:267-440-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health