Provider Demographics
NPI:1851589675
Name:NYLUND, KAITLIN MICHELE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MICHELE
Last Name:NYLUND
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WASHINGTON ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3518
Mailing Address - Country:US
Mailing Address - Phone:978-254-7044
Mailing Address - Fax:
Practice Address - Street 1:70 WASHINGTON ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3518
Practice Address - Country:US
Practice Address - Phone:978-254-7044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1161821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical