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General NPI Number Information
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NPI Number | 1346663408
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Entity Type | Individual
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Provider Name | KATHRYN FAHEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 123 QUARRY ST
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City | WILLIMANTIC
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State | CT
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Zip | 06226-1247
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Country | US
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Telephone | 860-465-2620
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Fax |
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Provider Business Mailing Address
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Address Line | 66 SUNDALE DR WINDHAM
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City | WINDHAM
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State | CT
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Zip | 06280-1231
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Country | US
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Telephone | 860-465-9087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 003230
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License Number State | CT
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