Provider Demographics
NPI:1962862573
Name:CONEITA, CATHERIN
Entity Type:Individual
Prefix:
First Name:CATHERIN
Middle Name:
Last Name:CONEITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2173
Mailing Address - Country:US
Mailing Address - Phone:207-596-3565
Mailing Address - Fax:
Practice Address - Street 1:25 THIRD ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2173
Practice Address - Country:US
Practice Address - Phone:207-596-3565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4721171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor