Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 2836 | MA |
NPI | 1114949625 |
---|---|
Provider Name | Dr. Kenneth L Laytin |
First Address | Plymouth, MA 02360-4742 |
Second Address | Plymouth, MA 02360-4742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1898485 | (05) | MA |
LA W03047 | BLUE CROSS BLUE SHIELD (01) | MA |