Provider Demographics
NPI:1023186277
Name:STEWART, KELLY L (LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:STEWART
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04268-5943
Mailing Address - Country:US
Mailing Address - Phone:207-739-2644
Mailing Address - Fax:207-739-2467
Practice Address - Street 1:235 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5943
Practice Address - Country:US
Practice Address - Phone:207-739-2644
Practice Address - Fax:207-739-2467
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2631104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker