Provider Demographics
NPI:1407964307
Name:O'KANE, KATHLEEN (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:O'KANE
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:PO BOX 984
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:MA
Mailing Address - Zip Code:01379-0984
Mailing Address - Country:US
Mailing Address - Phone:413-584-3929
Mailing Address - Fax:413-584-3939
Practice Address - Street 1:19 CENTER CT
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3006
Practice Address - Country:US
Practice Address - Phone:413-584-3929
Practice Address - Fax:413-584-3939
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1053051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA255339000OtherMAGELLAN PROVIDER NUMBER
MA768257OtherTUFTS
MA11665609OtherCAQH
MA42473OtherHEALTH NEW ENGLAND
MAOKP04115Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
MA768257OtherTUFTS