Provider Demographics
NPI:1073730404
Name:PAYSON, CATHARINE DELAPORTE (MSW)
Entity Type:Individual
Prefix:
First Name:CATHARINE
Middle Name:DELAPORTE
Last Name:PAYSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 COTTAGE FARMS ROAD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107
Mailing Address - Country:US
Mailing Address - Phone:207-615-1854
Mailing Address - Fax:
Practice Address - Street 1:585 FOREST AVE
Practice Address - Street 2:STE 1
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1519
Practice Address - Country:US
Practice Address - Phone:207-615-1854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC44391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME260980099Medicaid
ME260980099Medicaid