Provider Demographics
NPI:1306030457
Name:KELLEHER, PATRICIA V (MA,LCPC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:V
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:MA,LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 WALDO AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6941
Mailing Address - Country:US
Mailing Address - Phone:207-505-8561
Mailing Address - Fax:
Practice Address - Street 1:159 WALDO AVE APT 2
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6941
Practice Address - Country:US
Practice Address - Phone:207-505-8561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2066101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME288710099Medicaid