Provider Demographics
NPI:1114332186
Name:MORRISSETTE, KATHLEEN (LCPC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MORRISSETTE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BARLEY LN
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8442
Mailing Address - Country:US
Mailing Address - Phone:207-475-5737
Mailing Address - Fax:
Practice Address - Street 1:7 OAK HILL TER
Practice Address - Street 2:SUITE 211
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8996
Practice Address - Country:US
Practice Address - Phone:207-475-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-27
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health