Provider Demographics
NPI:1457968992
Name:O'CONNELL, KAITLIN WINSTON (CGC)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:WINSTON
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 CHARLES ST FL 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3002
Mailing Address - Country:US
Mailing Address - Phone:617-573-6785
Mailing Address - Fax:617-573-6901
Practice Address - Street 1:243 CHARLES ST FL 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3002
Practice Address - Country:US
Practice Address - Phone:617-573-6785
Practice Address - Fax:617-573-6901
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAGC602170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS