Kaitlyn Sullivan Martin, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

126248 Issued in MA

Practice address

20 Blacksmith Rd
Wilbraham, MA 01095-1312

Phone

(413) 244-5781

NPI assigned

Jul 17, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kaitlyn Sullivan Former name

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 413Therapy Group, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • East Longmeadow, MA
  • NPI 1184183790

  Clinical

  Medicare reassignment NPD
• Panda Bugs, Inc.

  • Clinical Social Worker
  • East Longmeadow, MA
  • NPI 1902697659
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1811676851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 BLACKSMITH RD",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010951312",
            "telephone_number": "413-244-5781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 BLACKSMITH RD",
            "city": "WILBRAHAM",
            "state": "MA",
            "postal_code": "010951312",
            "telephone_number": "413-244-5781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "KAITLYN",
        "middle_name": "SULLIVAN",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-17",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "126248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "SULLIVAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Priya Sharma Malik, M.D., M.P.H
• Julia Anne Mandsager Komatsu
• Sara Marcotte
• Maureen Q Margolis
• Michael Jonathan Margolis, D.D.S., PH.D.
• Joeenthonie Martinez
• Kimberly Joyal Martins, MD
• Matthews PCC LLC
• Michael McCool, PA-C
• Estephany Mena Deleon

• Clinical Social Worker in Wilbraham, MA
• Providers in Wilbraham, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.