Provider Demographics
NPI:1255844031
Name:FRADETTE, COLLEEN (LMHC, LCPC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:FRADETTE
Suffix:
Gender:F
Credentials:LMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 COTTAGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7368
Mailing Address - Country:US
Mailing Address - Phone:207-229-5357
Mailing Address - Fax:
Practice Address - Street 1:19 COTTAGEWOOD LN
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7368
Practice Address - Country:US
Practice Address - Phone:207-229-5357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-15
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9202101YM0800X
MECC5341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health