Provider Demographics
NPI:1508928359
Name:DAGNESE, KEVIN (LSW)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:DAGNESE
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3032
Mailing Address - Country:US
Mailing Address - Phone:207-662-3065
Mailing Address - Fax:207-842-7773
Practice Address - Street 1:932 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3032
Practice Address - Country:US
Practice Address - Phone:207-662-3065
Practice Address - Fax:207-842-7773
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS2975104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker