Provider Demographics
NPI:1134652589
Name:KRELL, NOAH DANIEL (LCSW)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:DANIEL
Last Name:KRELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2430
Mailing Address - Country:US
Mailing Address - Phone:207-417-6260
Mailing Address - Fax:
Practice Address - Street 1:57 EXCHANGE ST STE 203
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5000
Practice Address - Country:US
Practice Address - Phone:207-417-6260
Practice Address - Fax:207-569-9919
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC182011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical