Provider Demographics
NPI:1396110243
Name:JONES, KATHRYN (LCSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:E
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:63 TUCKER LN
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274-5959
Mailing Address - Country:US
Mailing Address - Phone:978-399-4524
Mailing Address - Fax:
Practice Address - Street 1:143 POTTLE RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:ME
Practice Address - Zip Code:04270-3362
Practice Address - Country:US
Practice Address - Phone:207-743-7911
Practice Address - Fax:207-743-7913
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221171104100000X
MELC170031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker