Healthcare Provider Details

I. General information

NPI: 1225162514
Provider Name (Legal Business Name): KATHLEEN C HARDWICK M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH STREET
SOUTHBRIDGE MA
01550
US

IV. Provider business mailing address

394 PROSPECT STREET P.O. BOX 205
EAST WOODSTOCK CT
06244
US

V. Phone/Fax

Practice location:
  • Phone: 508-765-9771
  • Fax:
Mailing address:
  • Phone: 508-826-2699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number203519
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: