Provider Demographics
NPI:1811106487
Name:DURKIN, KATHLEEN (LISW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:DURKIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23220 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5408
Mailing Address - Country:US
Mailing Address - Phone:216-556-4726
Mailing Address - Fax:216-464-0534
Practice Address - Street 1:23220 CHAGRIN BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5408
Practice Address - Country:US
Practice Address - Phone:216-556-4726
Practice Address - Fax:216-464-0534
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0008505104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000279817OtherANTHEM BLUE CROSS BLUE SH