Provider Demographics
NPI:1245929173
Name:CLOUD, KATHERYN JEANNE (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERYN
Middle Name:JEANNE
Last Name:CLOUD
Suffix:
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 1:88 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6123
Mailing Address - Country:US
Mailing Address - Phone:860-938-3925
Mailing Address - Fax:
Practice Address - Street 1:88 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6123
Practice Address - Country:US
Practice Address - Phone:860-938-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0101301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty