Provider Demographics
NPI:1326821612
Name:KELLEY, SARAH RENEE (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RENEE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHERN LIGHT MERCY HOSPITAL, 195 FORE RIVER PARKWAY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-553-6868
Mailing Address - Fax:207-904-0917
Practice Address - Street 1:NORTHERN LIGHT MERCY HOSPITAL
Practice Address - Street 2:195 FORE RIVER PARKWAY, SUITE 360
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-553-6868
Practice Address - Fax:207-904-0917
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC223271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical