Provider Demographics
NPI:1588764575
Name:COONEY, KATHLEEN FRANCES (LISW, LICDC)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:FRANCES
Last Name:COONEY
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WHITAKER CV
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-2349
Mailing Address - Country:US
Mailing Address - Phone:440-930-8108
Mailing Address - Fax:
Practice Address - Street 1:3416 COLUMBUS AVE
Practice Address - Street 2:SANDUSKY OUTPATIENT CLINIC 3RD FLOOR
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5557
Practice Address - Country:US
Practice Address - Phone:419-625-7350
Practice Address - Fax:419-625-6660
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00081941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical