Provider Demographics
NPI:1598013088
Name:SALTONSTALL, KATHARINE CHANNING (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:CHANNING
Last Name:SALTONSTALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:CHANNING
Other - Last Name:STOREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:76 BEDFORD ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:76 BEDFORD ST
Practice Address - Street 2:SUITE 12
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4646
Practice Address - Country:US
Practice Address - Phone:781-861-6655
Practice Address - Fax:781-861-6654
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2173731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical