Provider Demographics
NPI:1083231377
Name:CAHILL, KATHERINE ANNE (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANNE
Last Name:CAHILL
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:CAHILL-SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 173
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:13612
Mailing Address - Country:US
Mailing Address - Phone:315-782-3956
Mailing Address - Fax:
Practice Address - Street 1:22679 DUFFY ROAD
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601
Practice Address - Country:US
Practice Address - Phone:315-782-3956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000796101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health