Provider Demographics
NPI:1740490853
Name:MATTUCCI, KATHLEEN C (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:MATTUCCI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:HEYNEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 21096
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59104-1096
Mailing Address - Country:US
Mailing Address - Phone:406-259-7288
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:2475 VILLAGE LN
Practice Address - Street 2:SUITE 102
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2497
Practice Address - Country:US
Practice Address - Phone:406-259-7288
Practice Address - Fax:406-294-0967
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT519 LCSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT70096OtherBCBS