Provider Demographics
NPI:1891337358
Name:KITTREDGE, BETH (LCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:KITTREDGE
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 1:26 SCHOOL ST FLOOR 3
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-4710
Mailing Address - Country:US
Mailing Address - Phone:207-409-3730
Mailing Address - Fax:
Practice Address - Street 1:26 SCHOOL STREET 3RD FLOOR
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-0409
Practice Address - Country:US
Practice Address - Phone:207-409-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC182661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical