Provider Demographics
NPI:1003984899
Name:MADORE, KATHLEEN G (LCPC, LMSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:G
Last Name:MADORE
Suffix:
Gender:F
Credentials:LCPC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:ME
Mailing Address - Zip Code:04257-0078
Mailing Address - Country:US
Mailing Address - Phone:207-369-9350
Mailing Address - Fax:
Practice Address - Street 1:49 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2014
Practice Address - Country:US
Practice Address - Phone:207-364-7981
Practice Address - Fax:207-634-7983
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC559101YP2500X
MEMC41841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical