Provider Demographics
NPI:1659378834
Name:HANNAN, KATHLEEN E (LMSW,ACSW,CASAC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:HANNAN
Suffix:
Gender:F
Credentials:LMSW,ACSW,CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 DIMMICK ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3911
Mailing Address - Country:US
Mailing Address - Phone:315-788-2548
Mailing Address - Fax:
Practice Address - Street 1:502 DIMMICK ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3911
Practice Address - Country:US
Practice Address - Phone:315-788-2548
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7482859OtherEMPIRE VALUE OPTIONS
NY1130749Other1130749
NYKHA502136OtherBCBS EXCELLUS
NY7482859OtherGHI PLANS
NY87726OtherUBH
NY0005210341OtherAETNA
NY194066OtherTRICARE
NY61271OtherPRINCIPAL
NY1130749Other1130749