Healthcare Provider Details

I. General information

NPI: 1073399044
Provider Name (Legal Business Name): KACI BLAILOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MAPLE ST STE 4
MARLBOROUGH MA
01752-2494
US

IV. Provider business mailing address

670R MASSACHUSETTS AVE
ARLINGTON MA
02476-5003
US

V. Phone/Fax

Practice location:
  • Phone: 508-485-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: