Provider Demographics
NPI:1083447098
Name:SIEMPELKAMP, KAITLIN ANN (LCSW-MA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ANN
Last Name:SIEMPELKAMP
Suffix:
Gender:F
Credentials:LCSW-MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MALCOLM X BLVD UNIT 2-1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1775
Mailing Address - Country:US
Mailing Address - Phone:617-209-5543
Mailing Address - Fax:
Practice Address - Street 1:10 MALCOLM X BLVD UNIT 2-1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02119-1775
Practice Address - Country:US
Practice Address - Phone:617-209-5543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224916104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker