Provider Demographics
NPI:1467595371
Name:MATTESON, PAUL KENNETH (MSED, LCPC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:KENNETH
Last Name:MATTESON
Suffix:
Gender:M
Credentials:MSED, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 FICKETT RD
Mailing Address - Street 2:
Mailing Address - City:POWNAL
Mailing Address - State:ME
Mailing Address - Zip Code:04069-6157
Mailing Address - Country:US
Mailing Address - Phone:207-688-4043
Mailing Address - Fax:
Practice Address - Street 1:440 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2015
Practice Address - Country:US
Practice Address - Phone:207-753-0135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health