Provider Demographics
NPI:1942561642
Name:RACANELLI, KATHRYN (MA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:RACANELLI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1739
Mailing Address - Country:US
Mailing Address - Phone:978-524-7133
Mailing Address - Fax:978-524-7137
Practice Address - Street 1:127 RANTOUL ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4240
Practice Address - Country:US
Practice Address - Phone:978-524-7133
Practice Address - Fax:978-524-7137
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health