Provider Demographics
NPI:1992051122
Name:MASKOWITZ, KATHRYN LYN (LICSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYN
Last Name:MASKOWITZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:MASKOWITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:91 N STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-4300
Mailing Address - Country:US
Mailing Address - Phone:603-634-8822
Mailing Address - Fax:603-856-8061
Practice Address - Street 1:91 N STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-4300
Practice Address - Country:US
Practice Address - Phone:603-634-8822
Practice Address - Fax:603-856-8061
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH17971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3146789Medicaid