Provider Demographics
NPI:1346599925
Name:ADAMS, KATHRYN MARIE (LISW-S)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MARIE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 WOOSTER RD
Mailing Address - Street 2:APT. # 208
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-4174
Mailing Address - Country:US
Mailing Address - Phone:216-339-4483
Mailing Address - Fax:
Practice Address - Street 1:3420 WOOSTER RD
Practice Address - Street 2:APT #218
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-4174
Practice Address - Country:US
Practice Address - Phone:216-339-4483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS. 0900976104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker