Provider Demographics
NPI:1477883171
Name:HENNESSEY, KATHLEEN (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HENNESSEY
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 1:200 CHAUNCY ST STE 113
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1200
Mailing Address - Country:US
Mailing Address - Phone:508-784-1025
Mailing Address - Fax:508-552-9976
Practice Address - Street 1:200 CHAUNCY ST STE 113
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1200
Practice Address - Country:US
Practice Address - Phone:508-784-1025
Practice Address - Fax:508-552-9976
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW023191041C0700X
FLSW182331041C0700X
MA1168091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical