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General NPI Number Information
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NPI Number | 1447500723
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Entity Type | Individual
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Provider Name | KATE O LOGAN LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 176 MAIN ST
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City | SOUTHBRIDGE
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State | MA
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Zip | 01550-2561
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Country | US
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Telephone | 508-765-2725
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Fax |
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Provider Business Mailing Address
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Address Line | 31 CORNFIELD PT
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City | WOODSTOCK
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State | CT
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Zip | 06281-3003
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9196
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License Number State | CT
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