Healthcare Provider Details

I. General information

NPI: 1215535158
Provider Name (Legal Business Name): KATHERINE DUBOIS LCSW (DE) LICSW (MA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 01/07/2024
Certification Date: 01/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRANDYWINE BLVD
TALLEYVILLE DE
19803-1838
US

IV. Provider business mailing address

19 BRANDYWINE BLVD
TALLEYVILLE DE
19803-1838
US

V. Phone/Fax

Practice location:
  • Phone: 207-239-1480
  • Fax:
Mailing address:
  • Phone: 207-239-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number123791
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0012305
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: