Healthcare Provider Details

I. General information

NPI: 1760396220
Provider Name (Legal Business Name): KAITLYN ELIZABETH RICKARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 MORTON ST
MATTAPAN MA
02126-2834
US

IV. Provider business mailing address

247 PLEASANT ST UNIT 2
SOUTH WEYMOUTH MA
02190-2000
US

V. Phone/Fax

Practice location:
  • Phone: 617-533-2400
  • Fax:
Mailing address:
  • Phone: 585-217-6652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1143071
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: