Provider Demographics
NPI:1821105701
Name:JAMES, KATHY ELIZABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ELIZABETH
Last Name:JAMES
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 1:4 STARLING WAY
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-4767
Mailing Address - Country:US
Mailing Address - Phone:978-840-0667
Mailing Address - Fax:
Practice Address - Street 1:21 MURDOCK AVE
Practice Address - Street 2:WINCHENDON DAY ACTIVITY CENTER
Practice Address - City:WINCHENDON
Practice Address - State:MA
Practice Address - Zip Code:01475-1570
Practice Address - Country:US
Practice Address - Phone:978-297-3028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10237001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical