Provider Demographics
NPI:1669572301
Name:ANDERSON, KATHLEEN (LMHC)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WATER ST
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-5302
Mailing Address - Country:US
Mailing Address - Phone:413-207-2101
Mailing Address - Fax:
Practice Address - Street 1:195 RUSSELL ST
Practice Address - Street 2:SUITE B-8
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9515
Practice Address - Country:US
Practice Address - Phone:413-207-2101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health