MEDICARE: MS. KATHLEEN MARY WINKWORTH

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	104103	MA

General Provider Information

NPI Number	:	1972596781
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN MARY WINKWORTH

Provider Business Mailing Address
First Line	:	128 SHUTESBURY RD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9712
Country	:	US
Telephone Number	:	413-548-9566
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 SHUTESBURY RD
Second Line	:
City	:	LEVERETT
State	:	MA
Zip	:	01054-9712
Country	:	US
Telephone Number	:	413-548-9566
Fax Number	:

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	12/21/2011

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