Healthcare Provider Details

I. General information

NPI: 1073251849
Provider Name (Legal Business Name): KAITLYN TONKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HAWTHORNE ST
HAVERHILL MA
01835-7904
US

IV. Provider business mailing address

4 HAWTHORNE ST
HAVERHILL MA
01835-7904
US

V. Phone/Fax

Practice location:
  • Phone: 860-331-1149
  • Fax:
Mailing address:
  • Phone: 860-331-1149
  • Fax:

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: