Provider Demographics
NPI:1295907970
Name:WOODHOUSE, KATHERINE CAMERON (LICSW)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:CAMERON
Last Name:WOODHOUSE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 MAIN STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-644-0044
Mailing Address - Fax:413-644-0044
Practice Address - Street 1:284 MAIN STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230
Practice Address - Country:US
Practice Address - Phone:413-644-0044
Practice Address - Fax:413-644-0044
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1107341041C0700X
NYR04240911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ08048OtherBCBS