Provider Demographics
NPI:1154476604
Name:FENTON, KATHLEEN E (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:E
Last Name:FENTON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SALEM ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2114
Mailing Address - Country:US
Mailing Address - Phone:197-847-0117
Mailing Address - Fax:
Practice Address - Street 1:430 N CANAL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1246
Practice Address - Country:US
Practice Address - Phone:197-868-3950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health