Provider Demographics
NPI:1952321911
Name:JEAN, CATHERINE (LICSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:JEAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:R
Other - Last Name:LIBERTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:9 SCOTT FIELD
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969
Mailing Address - Country:US
Mailing Address - Phone:978-948-2183
Mailing Address - Fax:
Practice Address - Street 1:76 SUMMER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-5814
Practice Address - Country:US
Practice Address - Phone:978-373-8222
Practice Address - Fax:979-373-8223
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10264301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA62-00163OtherEVERCARE
MA800007710OtherRAIL ROAD MEDICARE
MAP20239Medicare ID - Type Unspecified