Provider Demographics
NPI:1245773449
Name:BENOIT, KATHLEEN (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:BENOIT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 JOHNSON WAY
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-2140
Mailing Address - Country:US
Mailing Address - Phone:774-369-0633
Mailing Address - Fax:
Practice Address - Street 1:45 STERLING ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1200
Practice Address - Country:US
Practice Address - Phone:774-369-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0001236751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical