Provider Demographics
NPI:1447402458
Name:MICHAEL, KATHLEEN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12186-9321
Mailing Address - Country:US
Mailing Address - Phone:518-424-4450
Mailing Address - Fax:
Practice Address - Street 1:67 SPRINGFIELD DR
Practice Address - Street 2:
Practice Address - City:VOORHEESVILLE
Practice Address - State:NY
Practice Address - Zip Code:12186-9321
Practice Address - Country:US
Practice Address - Phone:518-424-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR070113-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical