Provider Demographics
NPI:1477920775
Name:KERISH BENTTINEN LCSW, LLC
Entity Type:Organization
Organization Name:KERISH BENTTINEN LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KERISH
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTTINEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-649-9772
Mailing Address - Street 1:11 1ST RANGEWAY
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5161
Mailing Address - Country:US
Mailing Address - Phone:207-649-9772
Mailing Address - Fax:207-616-0577
Practice Address - Street 1:179 MAIN ST
Practice Address - Street 2:SUITE 401
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6672
Practice Address - Country:US
Practice Address - Phone:207-649-9772
Practice Address - Fax:207-616-0577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-22
Last Update Date:2015-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC13117101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty