Provider Demographics
NPI:1578644530
Name:PUTNEY, KATHLEEN TAYLOR (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:TAYLOR
Last Name:PUTNEY
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1712
Mailing Address - Country:US
Mailing Address - Phone:781-829-4459
Mailing Address - Fax:
Practice Address - Street 1:1093 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-2100
Practice Address - Country:US
Practice Address - Phone:617-872-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1066581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical