Provider Demographics
NPI:1477548022
Name:CARON, KATHLEEN A (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:CARON
Suffix:
Gender:F
Credentials:LICSW
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Mailing Address - Street 1:401 DIVISION ST S
Mailing Address - Street 2:STE C
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2096
Mailing Address - Country:US
Mailing Address - Phone:651-605-6020
Mailing Address - Fax:651-605-6020
Practice Address - Street 1:220 RAILROAD ST SE
Practice Address - Street 2:THERAPEUTIC SEREVICES AGANCY INC
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1540
Practice Address - Country:US
Practice Address - Phone:320-629-7600
Practice Address - Fax:320-629-7900
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2017-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN2092104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN909669800Medicaid