Provider Demographics
NPI:1902496854
Name:MENNE, KATHY MARY (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:MARY
Last Name:MENNE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMERSON HOSPITAL
Mailing Address - Street 2:133 OLD ROAD TO NINE ACRE CORNER
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-287-3190
Mailing Address - Fax:978-287-3695
Practice Address - Street 1:EMERSON HOSPITAL
Practice Address - Street 2:133 OLD ROAD TO NINE ACRE CORNER
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-287-3190
Practice Address - Fax:978-287-3695
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10188421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical