Provider Demographics
NPI:1184190514
Name:RIVER, KELLA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KELLA
Middle Name:
Last Name:RIVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 BEECHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:ME
Mailing Address - Zip Code:04861-3020
Mailing Address - Country:US
Mailing Address - Phone:207-691-1500
Mailing Address - Fax:
Practice Address - Street 1:91 CAMDEN ST STE 213
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2459
Practice Address - Country:US
Practice Address - Phone:207-691-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LC171911041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty