Provider Demographics
NPI:1154202026
Name:KINNANE, EILEEN MARY (SAC, LMHC)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARY
Last Name:KINNANE
Suffix:
Gender:F
Credentials:SAC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DEERING DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2808
Mailing Address - Country:US
Mailing Address - Phone:401-297-1532
Mailing Address - Fax:
Practice Address - Street 1:4 DEERING DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2808
Practice Address - Country:US
Practice Address - Phone:401-297-1532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC10002675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty