Healthcare Provider Details

I. General information

NPI: 1477081909
Provider Name (Legal Business Name): KAITLYN LEE HEGG MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2017
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 ROUTE 28
HARWICH PORT MA
02646-1604
US

IV. Provider business mailing address

307 DEPOT ST
DENNIS PORT MA
02639-1413
US

V. Phone/Fax

Practice location:
  • Phone: 508-681-9058
  • Fax:
Mailing address:
  • Phone: 508-681-9058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: