Provider Demographics
NPI:1982908042
Name:MOHLER-FARIA, KATHY LYNN (LICSW)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:LYNN
Last Name:MOHLER-FARIA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 SPINNAKER DR W
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3663
Mailing Address - Country:US
Mailing Address - Phone:508-681-5201
Mailing Address - Fax:
Practice Address - Street 1:65 TOWN HALL SQ
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2789
Practice Address - Country:US
Practice Address - Phone:508-681-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1060171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical