Provider Demographics
NPI:1952385395
Name:DEZENZO, KATHLEEN J (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:J
Last Name:DEZENZO
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 1:31 HALL DR
Mailing Address - Street 2:STE 1
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2778
Mailing Address - Country:US
Mailing Address - Phone:866-431-4077
Mailing Address - Fax:413-774-7448
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:AMHERST MEDICAL CENTER
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-8561
Practice Address - Fax:413-256-4412
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1066801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04647OtherBLUE CROSS BLUE SHIELD
MA1293395OtherFALLON
MA7337314OtherAETNA US/HEALTHCARE
MA2072422OtherCIGNA BEHAVIORAL HEALTH
MA106680OtherTUFTS HEALTH PLAN
MA28435OtherHEALTH NEW ENGLAND
MAP04647OtherBLUE CROSS BLUE SHIELD