Provider Demographics
NPI:1093221509
Name:KATHLEEN ERCOLINI LLC
Entity Type:Organization
Organization Name:KATHLEEN ERCOLINI LLC
Other - Org Name:KATHLEEN ERCOLINI, LICSW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ERCOLINI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:978-276-4260
Mailing Address - Street 1:60 MOUNT VERNON ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-2540
Mailing Address - Country:US
Mailing Address - Phone:978-276-4260
Mailing Address - Fax:
Practice Address - Street 1:60 MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2540
Practice Address - Country:US
Practice Address - Phone:978-276-4260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)