Provider Demographics
NPI:1548673437
Name:MCDONALD, KATHLEEN MARY (LICSW #110288 MED,)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:LICSW #110288 MED,
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:HENTSCHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, MSW
Mailing Address - Street 1:99 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052
Mailing Address - Country:US
Mailing Address - Phone:508-359-2341
Mailing Address - Fax:
Practice Address - Street 1:30 MECHANIC STREET
Practice Address - Street 2:KERZNER ASSOCIATES P.C.
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035
Practice Address - Country:US
Practice Address - Phone:508-543-2133
Practice Address - Fax:508-543-2133
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1102881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical