Provider Demographics
NPI:1073060703
Name:MCCANN, KATHERINE (MTS, MPHIL)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:MTS, MPHIL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 NE LIMA VIAS
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-6632
Mailing Address - Country:US
Mailing Address - Phone:772-342-7642
Mailing Address - Fax:
Practice Address - Street 1:590 NE LIMA VIAS
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-6632
Practice Address - Country:US
Practice Address - Phone:772-342-7642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-11
Last Update Date:2016-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health