Provider Demographics
NPI:1265911671
Name:BOVE, KATIE R (LCSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:R
Last Name:BOVE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:R
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6031
Mailing Address - Country:US
Mailing Address - Phone:207-795-4180
Mailing Address - Fax:207-753-6419
Practice Address - Street 1:75 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6031
Practice Address - Country:US
Practice Address - Phone:207-795-4180
Practice Address - Fax:207-753-6419
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1200991041C0700X
MELC160551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical