MEDICARE: DR. KENNETH L LAYTIN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	2836	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	LA W03047	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1114949625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH L LAYTIN PHD

Provider Business Mailing Address
First Line	:	125 PARADISE LN
Second Line	:
City	:	ROCHESTER
State	:	MA
Zip	:	02770-4043
Country	:	US
Telephone Number	:	508-746-4373
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 PARADISE LN
Second Line	:
City	:	ROCHESTER
State	:	MA
Zip	:	02770-4043
Country	:	US
Telephone Number	:	508-746-4373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	02/17/2023

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