Provider Demographics
NPI:1598880122
Name:NADEAU, KRISTY JO (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:JO
Last Name:NADEAU
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:JO
Other - Last Name:DUBOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:545 CARIBOU RD
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1526
Mailing Address - Country:US
Mailing Address - Phone:207-834-7260
Mailing Address - Fax:
Practice Address - Street 1:210 MARKET ST.
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743
Practice Address - Country:US
Practice Address - Phone:207-834-4470
Practice Address - Fax:207-834-4473
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC102731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical