MEDICARE: MS. KATHLEEN KILBORNE LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1032024	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P07984	OTHER	MA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1922033554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN KILBORNE LICSW

Provider Business Mailing Address
First Line	:	PO BOX 491
Second Line	:	5 LENOX ROAD
City	:	WEST STOCKBRIDGE
State	:	MA
Zip	:	01266-0491
Country	:	US
Telephone Number	:	413-232-0051
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 LENOX ROAD
Second Line	:
City	:	WEST STOCKBRIDGE
State	:	MA
Zip	:	01266-0491
Country	:	US
Telephone Number	:	413-232-4026
Fax Number	:	413-232-4026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/08/2008

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