Provider Demographics
NPI:1063390698
Name:GROOM-NGUYEN, KATHLEEN JEANNINE (MSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JEANNINE
Last Name:GROOM-NGUYEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:JEANNINE
Other - Last Name:GROOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 HILDA ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1333
Mailing Address - Country:US
Mailing Address - Phone:617-233-8559
Mailing Address - Fax:
Practice Address - Street 1:27 HILDA ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1333
Practice Address - Country:US
Practice Address - Phone:617-233-8559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219821104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker