Provider Demographics
NPI:1245968429
Name:FINNEGAN, KAYLA ROSE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ROSE
Last Name:FINNEGAN
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 1:129 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-2472
Mailing Address - Country:US
Mailing Address - Phone:774-280-9127
Mailing Address - Fax:
Practice Address - Street 1:35 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2101
Practice Address - Country:US
Practice Address - Phone:844-902-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARBT-22-225863103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst