Provider Demographics
NPI:1942337910
Name:SIMON, KATHLEEN MILLS I (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MILLS
Last Name:SIMON
Suffix:I
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01540-1949
Mailing Address - Country:US
Mailing Address - Phone:508-987-3958
Mailing Address - Fax:
Practice Address - Street 1:100 SOUTH STREET
Practice Address - Street 2:HMH SOCIAL SERVICES DEPT.
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550
Practice Address - Country:US
Practice Address - Phone:508-765-9771
Practice Address - Fax:508-764-2498
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2141881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical