| Doctor Name: | MRS. KATHLEEN MARIE D'FANTIS |
| NPI Number: | 1275914764 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MT-BC, CT |
| License Number: | |
| Business Practice Address: | 16600 W Sprague Rd Suite 245 Middleburg Heights, OH - 441306318 |
| Business Phone Number: | 4405230370 |
| Business Fax Number: | |
| Mailing Address: | 16600 W Sprague Rd, Suite 245 MIDDLEBURG HEIGHTS |
| State: | OH |
| Postal Code: | 441306318 |
| Phone Number: | 4405230370 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2015 |
| NPI Last Update Date: | 06/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |