Provider Demographics
NPI:1730663709
Name:DONNINO, KATHRYN FLOYD (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:FLOYD
Last Name:DONNINO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EULITA TER
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3307
Mailing Address - Country:US
Mailing Address - Phone:617-935-3789
Mailing Address - Fax:
Practice Address - Street 1:100 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1314
Practice Address - Country:US
Practice Address - Phone:617-559-9042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1134091041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool