Provider Demographics
NPI:1851850135
Name:BANKS, KAITLYN MAE (BS HUMAN SERVICES)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MAE
Last Name:BANKS
Suffix:
Gender:F
Credentials:BS HUMAN SERVICES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-1116
Mailing Address - Country:US
Mailing Address - Phone:508-335-2365
Mailing Address - Fax:
Practice Address - Street 1:15 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1116
Practice Address - Country:US
Practice Address - Phone:508-335-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU5281178604OtherCIGNA