Healthcare Provider Details

I. General information

NPI: 1578137881
Provider Name (Legal Business Name): KAYLIN KOCOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BEECH ST
HOLYOKE MA
01040-3968
US

IV. Provider business mailing address

655 SHELBURNE FALLS RD
CONWAY MA
01341-9701
US

V. Phone/Fax

Practice location:
  • Phone: 413-540-1234
  • Fax:
Mailing address:
  • Phone: 413-588-4324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: