Provider Demographics
NPI:1922033554
Name:KILBORNE, KATHLEEN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:KILBORNE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:BYRNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 491
Mailing Address - Street 2:5 LENOX ROAD
Mailing Address - City:WEST STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01266-0491
Mailing Address - Country:US
Mailing Address - Phone:413-232-0051
Mailing Address - Fax:
Practice Address - Street 1:5 LENOX ROAD
Practice Address - Street 2:
Practice Address - City:WEST STOCKBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01266-0491
Practice Address - Country:US
Practice Address - Phone:413-232-4026
Practice Address - Fax:413-232-4026
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10320241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07984OtherBLUE CROSS BLUE SHIELD
MABY P23675Medicare ID - Type UnspecifiedNATIONAL HERITAGE