Provider Demographics
NPI:1609269711
Name:MICHAUD, KAYLA CL (LCSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:CL
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:BOURGOIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-CC, MHRT-C
Mailing Address - Street 1:180 ACADEMY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3183
Mailing Address - Country:US
Mailing Address - Phone:207-554-2352
Mailing Address - Fax:207-554-2351
Practice Address - Street 1:88 FOX ST
Practice Address - Street 2:
Practice Address - City:MADAWASKA
Practice Address - State:ME
Practice Address - Zip Code:04756
Practice Address - Country:US
Practice Address - Phone:207-728-6727
Practice Address - Fax:207-728-7679
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC17407104100000X
101YM0800X
MELC192641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME01-0876859Medicaid