Provider Demographics
NPI:1457754244
Name:MORESCHI-SHERRY, KATHRYN
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MORESCHI-SHERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:L
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC-C, CADC
Mailing Address - Street 1:PO BOX 2522
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04116-2522
Mailing Address - Country:US
Mailing Address - Phone:207-899-6948
Mailing Address - Fax:207-221-1315
Practice Address - Street 1:131 OCEAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3649
Practice Address - Country:US
Practice Address - Phone:207-899-6948
Practice Address - Fax:207-221-1315
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5259101YA0400X
MEXL4335101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)