Healthcare Provider Details

I. General information

NPI: 1326520149
Provider Name (Legal Business Name): KAITLIN H LATORRE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 MOUNT AUBURN STREET
WATERTOWN MA
02472
US

IV. Provider business mailing address

18 DALE ST UNIT 8H
ANDOVER MA
01810-5664
US

V. Phone/Fax

Practice location:
  • Phone: 617-972-9400
  • Fax:
Mailing address:
  • Phone: 978-479-6608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number218970
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: