Provider Demographics
NPI:1124398383
Name:LODICO, KATHELEEN A (LMSW)
Entity Type:Individual
Prefix:
First Name:KATHELEEN
Middle Name:A
Last Name:LODICO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2600
Mailing Address - Country:US
Mailing Address - Phone:518-235-1100
Mailing Address - Fax:518-235-0079
Practice Address - Street 1:55 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2600
Practice Address - Country:US
Practice Address - Phone:518-235-1100
Practice Address - Fax:518-235-0079
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084315104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker