Provider Demographics
NPI:1346325552
Name:MACCLUSKIE, KATHRYN C (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:C
Last Name:MACCLUSKIE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26777 LORAIN RD STE 314
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3225
Mailing Address - Country:US
Mailing Address - Phone:440-734-0337
Mailing Address - Fax:
Practice Address - Street 1:26777 LORAIN RD STE 314
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3225
Practice Address - Country:US
Practice Address - Phone:440-734-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling