Provider Demographics
NPI:1467742379
Name:MCCAULEY, KATHLEEN KELLY (LCSW, LISAC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:KELLY
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:LCSW, LISAC
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 3862
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244-3862
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2435 E SOUTHERN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7628
Practice Address - Country:US
Practice Address - Phone:480-216-4785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 10224101YA0400X
AZLCSW 116221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)