Provider Demographics
NPI:1366470064
Name:COONEY, KATHRYN A (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:COONEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MEITNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6000
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW013081041C0700X
MA1256791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI411609OtherBLUE CHIP
RI27353-2OtherBLUE CROSS
RIKM23823Medicaid