Provider Demographics
NPI:1538824198
Name:BAUTISTA, KATHLEEN ANGELA LAGUINIA
Entity type:Individual
Prefix:
First Name:KATHLEEN ANGELA
Middle Name:LAGUINIA
Last Name:BAUTISTA
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 1:71 ALLEGHANY STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-3338
Mailing Address - Country:US
Mailing Address - Phone:857-294-1049
Mailing Address - Fax:617-254-3461
Practice Address - Street 1:69 ALLEGHANY STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-3338
Practice Address - Country:US
Practice Address - Phone:617-254-0964
Practice Address - Fax:617-254-5539
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAXXP962408529OtherBLUE CROSS BLUE SHIELD OF MA