MEDICARE: MS. KATHLEEN J. COUTU MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	106612	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	32433	OTHER	MA	HEALTH NEW ENGLAND
2	000000	OTHER	MA	UNITED BEHAVORIAL HEALTH
3	P05922	OTHER	MA	BLUE CROSS BLUE SHIELD
4	2158517	OTHER	MA	CIGNA
5	115927000	OTHER	MA	MAGELLAN

General Provider Information

NPI Number	:	1821025685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN J. COUTU MSW

Provider Business Mailing Address
First Line	:	32 E NORTHFIELD RD
Second Line	:
City	:	NORTHFIELD
State	:	MA
Zip	:	01360-9668
Country	:	US
Telephone Number	:	413-773-0009
Fax Number	:	412-772-0865

Provider Business Practice Location Address
First Line	:	32 E NORTHFIELD RD
Second Line	:
City	:	NORTHFIELD
State	:	MA
Zip	:	01360-9668
Country	:	US
Telephone Number	:	413-773-0009
Fax Number	:	412-772-0865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	04/27/2021

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