Provider Demographics
NPI:1760038400
Name:HASSETT, KATHRYN ELEANORA (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ELEANORA
Last Name:HASSETT
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 1:48 GILMAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3004
Mailing Address - Country:US
Mailing Address - Phone:207-662-2565
Mailing Address - Fax:
Practice Address - Street 1:48 GILMAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3004
Practice Address - Country:US
Practice Address - Phone:207-662-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC171401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty