Provider Demographics
NPI:1982616587
Name:SMITH, KATHLEEN CONFREY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:CONFREY
Last Name:SMITH
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 1:481 GOLDSTAR HIGHWAY
Mailing Address - Street 2:#301
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340
Mailing Address - Country:US
Mailing Address - Phone:860-449-0055
Mailing Address - Fax:860-449-0055
Practice Address - Street 1:481 GOLDSTAR HIGHWAY
Practice Address - Street 2:#301
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:860-449-0055
Practice Address - Fax:860-449-0055
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2784104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004204781Medicaid
191016OtherMHN
D2203554OtherOXFORD