Provider Demographics
NPI:1609417633
Name:HENNESSY, CATHERINE ROSE (LMHC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ROSE
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ROSE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:142 CANAL ST STE 142P
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4673
Mailing Address - Country:US
Mailing Address - Phone:978-209-8823
Mailing Address - Fax:
Practice Address - Street 1:142 CANAL ST STE 142P
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4673
Practice Address - Country:US
Practice Address - Phone:978-209-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303287OtherMBHP
MAM18633OtherBCBS
1004745OtherNHP
MA99618201OtherNETWORK HEALTH
MA0000023532OtherBMC
MA042611055OtherTAX ID
MA1004745OtherFALLON