Provider Demographics
NPI:1194853374
Name:POWERS, KATHRYN L (LICSW, CCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:L
Last Name:POWERS
Suffix:
Gender:F
Credentials:LICSW, CCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 GILCREAST ROAD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3566
Mailing Address - Country:US
Mailing Address - Phone:603-552-5155
Mailing Address - Fax:603-432-3371
Practice Address - Street 1:75 GILCREAST ROAD
Practice Address - Street 2:SUITE #200
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3566
Practice Address - Country:US
Practice Address - Phone:603-552-5155
Practice Address - Fax:603-432-3371
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009638Medicaid