Healthcare Provider Details

I. General information

NPI: 1265526792
Provider Name (Legal Business Name): CATHERINE CARLETON WASHBURN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATE C. WASHBURN LICSW

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 FIRST PARISH ROAD
SCITUATE MA
02066
US

IV. Provider business mailing address

3036 WEATHERBY CT
WILMINGTON NC
28405-7483
US

V. Phone/Fax

Practice location:
  • Phone: 781-545-4659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1016634
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012063
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: