Provider Demographics
NPI:1942075551
Name:KAYLA B OUELLETTE, LCSW LLC
Entity Type:Organization
Organization Name:KAYLA B OUELLETTE, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:OUELLETTELCSW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-713-9123
Mailing Address - Street 1:8 OLD BUXTON RD
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-9553
Mailing Address - Country:US
Mailing Address - Phone:207-713-9123
Mailing Address - Fax:
Practice Address - Street 1:110 MAIN ST STE 1103
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3516
Practice Address - Country:US
Practice Address - Phone:207-713-9123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty