Healthcare Provider Details

I. General information

NPI: 1376456426
Provider Name (Legal Business Name): KAITLIN DRUMMATTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 HUSKY LANE
MALONE NY
12953
US

IV. Provider business mailing address

PO BOX 847
MALONE NY
12953-0847
US

V. Phone/Fax

Practice location:
  • Phone: 518-483-7801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131950
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: