Healthcare Provider Details
I. General information
NPI: 1619428984
Provider Name (Legal Business Name): KATHLEEN ANN KILLEEN LICSW, MLADC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 10/20/2016
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
173 MIDDLE ST
LANCASTER NH
03584-3508
US
IV. Provider business mailing address
173 MIDDLE ST
LANCASTER NH
03584-3508
US
V. Phone/Fax
- Phone: 603-788-4911
- Fax:
- Phone: 603-788-4911
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | LC7484 |
| License Number State | ME |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 9733 |
| License Number State | PA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 1637 |
| License Number State | DE |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 1201 |
| License Number State | NH |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 101YA0400X |
| Taxonomy | Addiction (Substance Use Disorder) Counselor |
| License Number | 1510134098 |
| License Number State | VT |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 104100000X |
| Taxonomy | Social Worker |
| License Number | SW123039 |
| License Number State | PA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 104100000X |
| Taxonomy | Social Worker |
| License Number | 17282 |
| License Number State | MD |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 104100000X |
| Taxonomy | Social Worker |
| License Number | 44SL05713500 |
| License Number State | NJ |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | Q1-0001255 |
| License Number State | DE |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 0890134255 |
| License Number State | VT |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | LC18875 |
| License Number State | ME |
| # 12 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 2248 |
| License Number State | NH |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
