Basic Information
Provider Information
NPI: 1003139262
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DIFRAIA
FirstName: KATHY
MiddleName: J
NamePrefix: MRS.
NameSuffix:  
Credential: M.ED.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 15 UNION STREET
Address2: SOUTH BAY MENTAL HEALTH
City: LAWRENCE
State: MA
PostalCode: 01840
CountryCode: US
TelephoneNumber: 9786884830
FaxNumber: 9786884901
Practice Location
Address1: 15 UNION STREET
Address2: SOUTH BAY MENTAL HEALTH
City: LAWRENCE
State: MA
PostalCode: 018403803
CountryCode: US
TelephoneNumber: 9786884830
FaxNumber: 9786884901
Other Information
ProviderEnumerationDate: 03/02/2010
LastUpdateDate: 09/26/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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