Healthcare Provider Details

I. General information

NPI: 1780650887
Provider Name (Legal Business Name): KATHLEEN ANN SIROIS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 WASHINGTON STREET
SALEM MA
01970-5462
US

IV. Provider business mailing address

PO BOX 8121
LYNN MA
01904-0121
US

V. Phone/Fax

Practice location:
  • Phone: 978-745-0078
  • Fax: 781-735-0267
Mailing address:
  • Phone: 978-745-0078
  • Fax: 781-735-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5579
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: