Provider Demographics
NPI:1316956022
Name:ADAIR, CATHY ILENE (LCSW)
Entity type:Individual
Prefix:MS
First Name:CATHY
Middle Name:ILENE
Last Name:ADAIR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N STONINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-3605
Mailing Address - Country:US
Mailing Address - Phone:860-536-8622
Mailing Address - Fax:
Practice Address - Street 1:190 N STONINGTON RD
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-3605
Practice Address - Country:US
Practice Address - Phone:860-536-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0057341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical