Provider Demographics
NPI:1225162514
Name:HARDWICK, KATHLEEN C (MA)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:C
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 PROSPECT STREET
Mailing Address - Street 2:P.O. BOX 205
Mailing Address - City:EAST WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06244
Mailing Address - Country:US
Mailing Address - Phone:508-826-2699
Mailing Address - Fax:
Practice Address - Street 1:100 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550
Practice Address - Country:US
Practice Address - Phone:508-765-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2035191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical