Provider Demographics
NPI:1285248849
Name:MILLS, KATHLEEN JS (PHD, LICSW)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JS
Last Name:MILLS
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:J
Other - Last Name:SAVAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:971 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01523-2569
Mailing Address - Country:US
Mailing Address - Phone:978-368-4878
Mailing Address - Fax:
Practice Address - Street 1:971 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01523-2569
Practice Address - Country:US
Practice Address - Phone:978-368-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10293071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1029307OtherBOARD OF SOCIAL WORKERS