Provider Demographics
NPI:1396392742
Name:MULCAHY, KIERSTEN (LCSW)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:
Last Name:MULCAHY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 MORNING ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2069
Mailing Address - Country:US
Mailing Address - Phone:201-264-1695
Mailing Address - Fax:
Practice Address - Street 1:22 FREE ST STE 402
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3900
Practice Address - Country:US
Practice Address - Phone:207-358-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC174551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty