Provider Demographics
NPI:1114179496
Name:VAIL, KATHLEEN ROBINSON (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ROBINSON
Last Name:VAIL
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 1:1496 STEFANI CIR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-7730
Mailing Address - Country:US
Mailing Address - Phone:850-494-3083
Mailing Address - Fax:
Practice Address - Street 1:1496 STEFANI CIR
Practice Address - Street 2:
Practice Address - City:CANTONMENT
Practice Address - State:FL
Practice Address - Zip Code:32533-7730
Practice Address - Country:US
Practice Address - Phone:850-494-3083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 25581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical