Provider Demographics
NPI:1285333633
Name:KATELYN ANDERSON LICSW
Entity type:Organization
Organization Name:KATELYN ANDERSON LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENTLY LICENSED THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATELYN
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:781-258-2538
Mailing Address - Street 1:165 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-1407
Mailing Address - Country:US
Mailing Address - Phone:781-258-2538
Mailing Address - Fax:
Practice Address - Street 1:35 VILLAGE RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:MA
Practice Address - Zip Code:01949-1238
Practice Address - Country:US
Practice Address - Phone:781-258-2538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty