Provider Demographics
NPI:1760573539
Name:CHAZIN, KATHY (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:CHAZIN
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 1:10 CALDWELL RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5735
Mailing Address - Country:US
Mailing Address - Phone:207-626-3448
Mailing Address - Fax:207-626-3453
Practice Address - Street 1:10 CALDWELL RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5735
Practice Address - Country:US
Practice Address - Phone:207-626-3448
Practice Address - Fax:207-626-3453
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC40101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1760573539Medicaid
ME1760573539Medicaid
ME1760573539Medicaid