Provider Demographics
NPI:1982898847
Name:WAGGONER, KATHARINE J (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:J
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MS
Other - First Name:KATHARINE
Other - Middle Name:J
Other - Last Name:MELANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 COLLEGE ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1148
Mailing Address - Country:US
Mailing Address - Phone:413-534-7400
Mailing Address - Fax:
Practice Address - Street 1:9 COLLEGE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1148
Practice Address - Country:US
Practice Address - Phone:413-534-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2591162451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical