Provider Demographics
NPI:1568424059
Name:KEHOE, MAUREEN G (LCSW)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:G
Last Name:KEHOE
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 1:51 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:ME
Mailing Address - Zip Code:04847
Mailing Address - Country:US
Mailing Address - Phone:207-596-2010
Mailing Address - Fax:207-596-2028
Practice Address - Street 1:400 BROADWAY
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841
Practice Address - Country:US
Practice Address - Phone:207-596-2010
Practice Address - Fax:207-596-2028
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC79211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME312190099Medicaid