Provider Demographics
NPI:1629582747
Name:CIRAOLO, KATHRYN ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANN
Last Name:CIRAOLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2479
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873
Mailing Address - Country:US
Mailing Address - Phone:267-374-0825
Mailing Address - Fax:
Practice Address - Street 1:215 ADAMS STREET
Practice Address - Street 2:PO BOX 2479
Practice Address - City:THOMPSON FALLA
Practice Address - State:MT
Practice Address - Zip Code:59873
Practice Address - Country:US
Practice Address - Phone:267-374-0825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT231881041C0700X
PACW0155851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical