Provider Demographics
NPI:1649334756
Name:KLEIN, KATHRYN ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 WILDERNESS DR
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:ME
Mailing Address - Zip Code:04460-3001
Mailing Address - Country:US
Mailing Address - Phone:207-746-5736
Mailing Address - Fax:207-746-5736
Practice Address - Street 1:73 WILDERNESS DR
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:ME
Practice Address - Zip Code:04460-3001
Practice Address - Country:US
Practice Address - Phone:207-746-5736
Practice Address - Fax:207-746-5736
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC35681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME233210099Medicaid
ME233210099Medicaid