Provider Demographics
NPI:1689280737
Name:COSLETT, CATHERINE AUDREY (CADC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:AUDREY
Last Name:COSLETT
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 GORHAM RD STE 8
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2317
Mailing Address - Country:US
Mailing Address - Phone:207-560-3717
Mailing Address - Fax:207-253-1546
Practice Address - Street 1:343 GORHAM RD STE 8
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2317
Practice Address - Country:US
Practice Address - Phone:207-560-3717
Practice Address - Fax:207-253-1546
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC7173101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)