Healthcare Provider Details

I. General information

NPI: 1740311331
Provider Name (Legal Business Name): KATHRYN M O'LOUGHLIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

332 E MAIN ST
MOUNT KISCO NY
10549-3005
US

IV. Provider business mailing address

16 OLD SHOP RD
CROSS RIVER NY
10518-1402
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-0191
  • Fax:
Mailing address:
  • Phone: 914-672-5608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number069211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: