Provider Demographics
NPI:1467293035
Name:BROCK, KAYTLIN M (MA)
Entity type:Individual
Prefix:
First Name:KAYTLIN
Middle Name:M
Last Name:BROCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 N 12TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1225
Mailing Address - Country:US
Mailing Address - Phone:717-831-8452
Mailing Address - Fax:
Practice Address - Street 1:635 N 12TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1225
Practice Address - Country:US
Practice Address - Phone:717-831-8452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health