Provider Demographics
NPI:1427539378
Name:BICKMORE, KELLY H (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:H
Last Name:BICKMORE
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 1:980 FOREST AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3336
Mailing Address - Country:US
Mailing Address - Phone:207-347-6106
Mailing Address - Fax:207-347-6113
Practice Address - Street 1:980 FOREST AVE STE 207
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3336
Practice Address - Country:US
Practice Address - Phone:207-347-6106
Practice Address - Fax:207-347-6113
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC64821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical