Provider Demographics
NPI:1821476037
Name:NELSON, KATHERINE (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:NELSON
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 1:36 N BEDFORD ST STE C22
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1186
Mailing Address - Country:US
Mailing Address - Phone:617-657-9389
Mailing Address - Fax:
Practice Address - Street 1:36 N BEDFORD ST STE C22
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1186
Practice Address - Country:US
Practice Address - Phone:617-657-9389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-08
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA1206741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical