Provider Demographics
NPI:1154838225
Name:KINNEY, PAUL PHILLIP JR (LCPC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:PHILLIP
Last Name:KINNEY
Suffix:JR
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 LAKE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04220-5242
Mailing Address - Country:US
Mailing Address - Phone:207-712-7286
Mailing Address - Fax:
Practice Address - Street 1:79 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5811
Practice Address - Country:US
Practice Address - Phone:207-712-7286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC7053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional