Healthcare Provider Details

I. General information

NPI: 1972596781
Provider Name (Legal Business Name): MS. KATHLEEN MARY WINKWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 SHUTESBURY RD
LEVERETT MA
01054-9712
US

IV. Provider business mailing address

128 SHUTESBURY RD
LEVERETT MA
01054-9712
US

V. Phone/Fax

Practice location:
  • Phone: 413-548-9566
  • Fax:
Mailing address:
  • Phone: 413-548-9566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104103
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: