Provider Demographics
NPI:1063057750
Name:PARENT, KAITLIN LOUISE
Entity type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:LOUISE
Last Name:PARENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 WARD KLINE RD
Mailing Address - Street 2:
Mailing Address - City:MYERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21773-9105
Mailing Address - Country:US
Mailing Address - Phone:240-674-1707
Mailing Address - Fax:
Practice Address - Street 1:649 GUILFORD AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6349
Practice Address - Country:US
Practice Address - Phone:240-651-9432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-19-106402106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician