Basic Information
| Provider Information | |||||||||
| NPI: | 1942378104 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KANE | ||||||||
| FirstName: | CATHY | ||||||||
| MiddleName: | COURTNEY | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 CURRIE HALL PKWY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442404312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306735812 | ||||||||
| FaxNumber: | 3306737162 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 CURRIE HALL PKWY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442404312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306735812 | ||||||||
| FaxNumber: | 3306737162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 12/09/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 4816 | OH | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 197387000 | 01 | OH | MAGELLAN | OTHER | 70981 | 01 | OH | QUAL CHOICE | OTHER | 1015118 | 01 | OH | CIGNA | OTHER | 000000345254 | 01 | ANTHEM | OTHER | 0971613 | 05 | OH | MEDICAID |