Provider Demographics
NPI:1053820480
Name:FEDE, KATHRYN ALAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ALAYNE
Last Name:FEDE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 TRUMPET DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23437-9060
Mailing Address - Country:US
Mailing Address - Phone:757-729-3859
Mailing Address - Fax:
Practice Address - Street 1:224 GREAT BRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3904
Practice Address - Country:US
Practice Address - Phone:757-547-9334
Practice Address - Fax:757-819-6326
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040101181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904010118OtherLCSW