Provider Demographics
NPI:1457163990
Name:GORMLEY, KACEY LEE (LMSW, CCLS)
Entity type:Individual
Prefix:
First Name:KACEY
Middle Name:LEE
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:LMSW, CCLS
Other - Prefix:
Other - First Name:KACEY
Other - Middle Name:LEE
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:645 SPORT HILL RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06612-1428
Mailing Address - Country:US
Mailing Address - Phone:512-294-3587
Mailing Address - Fax:
Practice Address - Street 1:205 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3206
Practice Address - Country:US
Practice Address - Phone:512-294-3587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9394104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker