Healthcare Provider Details

I. General information

NPI: 1114949625
Provider Name (Legal Business Name): KENNETH L LAYTIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARADISE LN
ROCHESTER MA
02770-4043
US

IV. Provider business mailing address

125 PARADISE LN
ROCHESTER MA
02770-4043
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-4373
  • Fax:
Mailing address:
  • Phone: 508-746-4373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number2836
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: