Healthcare Provider Details

I. General information

NPI: 1295896702
Provider Name (Legal Business Name): KATHERINE ANN MCCLOSKEY MSW/ LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WEST ST STE 14
MILLBURY MA
01527-2677
US

IV. Provider business mailing address

22 WEST ST STE 14
MILLBURY MA
01527-2677
US

V. Phone/Fax

Practice location:
  • Phone: 508-667-7287
  • Fax:
Mailing address:
  • Phone: 508-667-7287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number116958
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: