Provider Demographics
NPI:1396882098
Name:LANTIEGNE, KATHLEEN C (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:C
Last Name:LANTIEGNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:DEBLOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:MA
Mailing Address - Zip Code:01612-1510
Mailing Address - Country:US
Mailing Address - Phone:
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:978-368-4801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA216337104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker