Provider Demographics
NPI:1366625543
Name:NELLIGAN, KATE (LISW)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:
Last Name:NELLIGAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 738
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-0738
Mailing Address - Country:US
Mailing Address - Phone:803-276-5690
Mailing Address - Fax:803-321-2234
Practice Address - Street 1:800 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-3351
Practice Address - Country:US
Practice Address - Phone:803-276-5690
Practice Address - Fax:803-321-2234
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC66891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAD35NEMedicaid