Provider Demographics
NPI:1811391238
Name:BIRKETT, KAITLYN HUNT
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:HUNT
Last Name:BIRKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:979 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6625
Mailing Address - Country:US
Mailing Address - Phone:508-989-1880
Mailing Address - Fax:
Practice Address - Street 1:386 STANLEY ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-6009
Practice Address - Country:US
Practice Address - Phone:508-679-5222
Practice Address - Fax:508-673-3182
Is Sole Proprietor?:No
Enumeration Date:2014-10-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22580101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)