Healthcare Provider Details

I. General information

NPI: 1538824198
Provider Name (Legal Business Name): KATHLEEN ANGELA LAGUINIA BAUTISTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 ALLEGHANY STREET
BOSTON MA
02120-3338
US

IV. Provider business mailing address

71 ALLEGHANY STREET
BOSTON MA
02120-3338
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-0964
  • Fax: 617-254-5539
Mailing address:
  • Phone: 857-294-1049
  • Fax: 617-254-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: