Provider Demographics
NPI:1881857233
Name:LINEHAN, KATHLEEN E (MS, LLP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:LINEHAN
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22255 GREENFIELD RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3729
Mailing Address - Country:US
Mailing Address - Phone:248-849-3301
Mailing Address - Fax:
Practice Address - Street 1:22255 GREENFIELD RD STE 300
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3729
Practice Address - Country:US
Practice Address - Phone:248-849-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361002323103TC0700X
1041C0700X
MI6301013889103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical