Provider Demographics
NPI:1366454936
Name:LANDFAIR, KAELEN J (LMSW CONDITIONAL)
Entity Type:Individual
Prefix:
First Name:KAELEN
Middle Name:J
Last Name:LANDFAIR
Suffix:
Gender:F
Credentials:LMSW CONDITIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25A JUNE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-2642
Mailing Address - Country:US
Mailing Address - Phone:207-324-1500
Mailing Address - Fax:207-282-7509
Practice Address - Street 1:25A JUNE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2642
Practice Address - Country:US
Practice Address - Phone:207-324-1500
Practice Address - Fax:207-282-7509
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC10227104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker