Provider Demographics
NPI:1902364847
Name:KATHRYN MCNEISH LMFT, LLC
Entity Type:Organization
Organization Name:KATHRYN MCNEISH LMFT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-368-5515
Mailing Address - Street 1:140 LAKE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4161
Mailing Address - Country:US
Mailing Address - Phone:203-900-7137
Mailing Address - Fax:
Practice Address - Street 1:140 LAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4161
Practice Address - Country:US
Practice Address - Phone:203-900-7137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004069985Medicaid