Provider Demographics
NPI:1184796617
Name:ANDOLINA, KATHLEEN MARIE (RN, CS, PC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:ANDOLINA
Suffix:
Gender:F
Credentials:RN, CS, PC
Other - Prefix:
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Mailing Address - Street 1:11 STUART ST
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-3136
Mailing Address - Country:US
Mailing Address - Phone:508-359-2506
Mailing Address - Fax:617-250-8502
Practice Address - Street 1:82 MARLBOROUGH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2020
Practice Address - Country:US
Practice Address - Phone:774-469-0299
Practice Address - Fax:617-250-8502
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA145820163WP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS53785Medicare UPIN
MANS0126Medicare ID - Type UnspecifiedMEDICARE