Provider Demographics
NPI:1841788486
Name:CHEWEY, KAITLYN R
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:R
Last Name:CHEWEY
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 1:105 E WELLS ST APT D455
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4874
Mailing Address - Country:US
Mailing Address - Phone:908-489-3225
Mailing Address - Fax:
Practice Address - Street 1:105 E WELLS ST APT D455
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4874
Practice Address - Country:US
Practice Address - Phone:908-489-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA380103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst