Provider Demographics
NPI:1881175198
Name:CHRISTIE, KATHLEEN ANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5476 HANCOCK HWY
Mailing Address - Street 2:
Mailing Address - City:EQUINUNK
Mailing Address - State:PA
Mailing Address - Zip Code:18417-3116
Mailing Address - Country:US
Mailing Address - Phone:845-293-2143
Mailing Address - Fax:
Practice Address - Street 1:3 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CALLICOON
Practice Address - State:NY
Practice Address - Zip Code:12723-7714
Practice Address - Country:US
Practice Address - Phone:845-293-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071725-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical