Healthcare Provider Details

I. General information

NPI: 1306642103
Provider Name (Legal Business Name): KAYLEE LARTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date: 09/14/2025
Reactivation Date: 07/21/2026

III. Provider practice location address

396 WASHINGTON ST # 266
WELLESLEY HILLS MA
02481-6209
US

IV. Provider business mailing address

8038 BIENVILLE DR APT C306
NASHVILLE TN
37211-7543
US

V. Phone/Fax

Practice location:
  • Phone: 855-438-8331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2144069
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14889
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: