Healthcare Provider Details

I. General information

NPI: 1356828958
Provider Name (Legal Business Name): KATELYN ELIZABETH LEVESQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 HARVEY LN
WHITMAN MA
02382-1948
US

IV. Provider business mailing address

4 W PUBLIC ST
ASSONET MA
02702-1649
US

V. Phone/Fax

Practice location:
  • Phone: 617-388-1375
  • Fax:
Mailing address:
  • Phone: 617-388-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number9609783
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: