Provider Demographics
NPI:1649539669
Name:STILWELL, OMM KATHRYN (LMSW-CC)
Entity type:Individual
Prefix:
First Name:OMM
Middle Name:KATHRYN
Last Name:STILWELL
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:OMM
Other - Middle Name:KATHRYN
Other - Last Name:LUCARELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-CC
Mailing Address - Street 1:36 SWEETSER DR
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7592
Mailing Address - Country:US
Mailing Address - Phone:207-930-2711
Mailing Address - Fax:
Practice Address - Street 1:36 SWEETSER DR
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7592
Practice Address - Country:US
Practice Address - Phone:207-930-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC132201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical