Provider Demographics
NPI:1598402521
Name:CASEY, KAITLYN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:CASEY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MAIN ST STE 401
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1562
Mailing Address - Country:US
Mailing Address - Phone:508-290-0539
Mailing Address - Fax:781-803-2952
Practice Address - Street 1:1221 MAIN ST STE 401
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1562
Practice Address - Country:US
Practice Address - Phone:508-290-0539
Practice Address - Fax:781-803-2952
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health