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NPI Code Detail

MEDICARE: KAITLYN BASTARACHE

MEDICARE: KAITLYN BASTARACHE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
21041C0700XClinical Social WorkerLCSW230485MA

General Provider Information

NPI Number : 1245977677
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN BASTARACHE
Provider Business Mailing Address
First Line : 581 FAUNCE CORNER RD
Second Line :
City : DARTMOUTH
State : MA
Zip : 02747-1242
Country : US
Telephone Number : 508-207-9800
Fax Number :
Provider Business Practice Location Address
First Line : 581 FAUNCE CORNER RD
Second Line :
City : DARTMOUTH
State : MA
Zip : 02747-1242
Country : US
Telephone Number : 508-207-9800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2022
Last Update Date : 04/12/2026

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Directions to “ KAITLYN BASTARACHE ” Practice Location

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