Basic Information
Provider Information | |||||||||
NPI: | 1053974915 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | JOSEY DEMAIO | ||||||||
FirstName: | KATHERINE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 473 RIDGE RD | ||||||||
Address2: |   | ||||||||
City: | WILBRAHAM | ||||||||
State: | MA | ||||||||
PostalCode: | 010952311 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9783493021 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 200 N MAIN ST STE 8 | ||||||||
Address2: |   | ||||||||
City: | EAST LONGMEADOW | ||||||||
State: | USA | ||||||||
PostalCode: | 01028 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8604617792 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/17/2019 | ||||||||
LastUpdateDate: | 10/28/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/11/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 224593 | MA | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.