Healthcare Provider Details

I. General information

NPI: 1215002282
Provider Name (Legal Business Name): KATHLEEN MCCARTHY-TAYLOR M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 ELM ST STE 100
WORCESTER MA
01609-1903
US

IV. Provider business mailing address

130 ELM ST STE 100
WORCESTER MA
01609-1903
US

V. Phone/Fax

Practice location:
  • Phone: 508-753-3960
  • Fax: 508-753-1875
Mailing address:
  • Phone: 508-753-3960
  • Fax: 508-753-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106046
License Number StateMA

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: