Provider Demographics
NPI:1588142707
Name:CENNAMO, KATHERINE ALICE (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ALICE
Last Name:CENNAMO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:K
Other - Middle Name:ALICE
Other - Last Name:CENNAMO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:363 GRAPHITE RD
Mailing Address - Street 2:
Mailing Address - City:OLD FORT
Mailing Address - State:NC
Mailing Address - Zip Code:28762-9455
Mailing Address - Country:US
Mailing Address - Phone:828-678-1007
Mailing Address - Fax:
Practice Address - Street 1:363 GRAPHITE RD
Practice Address - Street 2:
Practice Address - City:OLD FORT
Practice Address - State:NC
Practice Address - Zip Code:28762-9455
Practice Address - Country:US
Practice Address - Phone:828-668-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0115611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical