Healthcare Provider Details

I. General information

NPI: 1477889327
Provider Name (Legal Business Name): KATHERYN KLEITSAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HARRISON AVE DOWLING 9
BOSTON MA
02118-4001
US

IV. Provider business mailing address

850 HARRISON AVE DOWLING 9
BOSTON MA
02118-4001
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-2041
  • Fax: 617-414-1975
Mailing address:
  • Phone: 617-414-2041
  • Fax: 617-414-1975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120201
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: