Provider Demographics
NPI:1356765382
Name:KASSAY, KATHLEEN EGAN (LICSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:EGAN
Last Name:KASSAY
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 1:349 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1715
Mailing Address - Country:US
Mailing Address - Phone:617-661-3991
Mailing Address - Fax:
Practice Address - Street 1:275 MARTINE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02723-1516
Practice Address - Country:US
Practice Address - Phone:508-431-8469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical