Provider Demographics
NPI:1215535158
Name:DUBOIS, KATHERINE (LCSW (DE) LICSW (MA))
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:LCSW (DE) LICSW (MA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRANDYWINE BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLEYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19803-1838
Mailing Address - Country:US
Mailing Address - Phone:207-239-1480
Mailing Address - Fax:
Practice Address - Street 1:19 BRANDYWINE BLVD
Practice Address - Street 2:
Practice Address - City:TALLEYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19803-1838
Practice Address - Country:US
Practice Address - Phone:207-239-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1237911041C0700X
DEQ1-00123051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical