Provider Demographics
NPI:1346347176
Name:KASSEL, JEANNETTE LISA (LCPC)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTE
Middle Name:LISA
Last Name:KASSEL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:KASSEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:KENTS HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04349-0086
Mailing Address - Country:US
Mailing Address - Phone:207-557-2306
Mailing Address - Fax:
Practice Address - Street 1:66 STONE ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5227
Practice Address - Country:US
Practice Address - Phone:207-557-2306
Practice Address - Fax:207-626-3612
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC 516101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431509899Medicaid