Provider Demographics
NPI:1215313051
Name:KATHRINE SULLIVAN-CORBETT LMHC
Entity type:Organization
Organization Name:KATHRINE SULLIVAN-CORBETT LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:978-880-8968
Mailing Address - Street 1:93 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3847
Mailing Address - Country:US
Mailing Address - Phone:978-880-8968
Mailing Address - Fax:978-418-9167
Practice Address - Street 1:93 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3847
Practice Address - Country:US
Practice Address - Phone:978-880-8968
Practice Address - Fax:978-418-9167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7168302F00000X, 302R00000X, 305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service