Healthcare Provider Details

I. General information

NPI: 1821025685
Provider Name (Legal Business Name): KATHLEEN J. COUTU MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 E NORTHFIELD RD
NORTHFIELD MA
01360-9668
US

IV. Provider business mailing address

32 E NORTHFIELD RD
NORTHFIELD MA
01360-9668
US

V. Phone/Fax

Practice location:
  • Phone: 413-773-0009
  • Fax: 412-772-0865
Mailing address:
  • Phone: 413-773-0009
  • Fax: 412-772-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106612
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: