Provider Demographics
NPI:1518148527
Name:KALILL, KATHLEEN SULLIVAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:SULLIVAN
Last Name:KALILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:MARION
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:60 ASAS RD
Mailing Address - Street 2:
Mailing Address - City:EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02642-1545
Mailing Address - Country:US
Mailing Address - Phone:774-722-0403
Mailing Address - Fax:
Practice Address - Street 1:60 ASAS RD
Practice Address - Street 2:
Practice Address - City:EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02642-1545
Practice Address - Country:US
Practice Address - Phone:774-722-0403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health