Provider Demographics
NPI:1902335664
Name:CANTRELL, KATHRYN (CCLS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 RUTLAND SQ APT 5
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3159
Mailing Address - Country:US
Mailing Address - Phone:254-913-9205
Mailing Address - Fax:
Practice Address - Street 1:47 RUTLAND SQ APT 5
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3159
Practice Address - Country:US
Practice Address - Phone:254-913-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health