Provider Demographics
NPI:1720524283
Name:KAZILIONIS, HANNAH ROSE (LCSW, LADC)
Entity Type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:ROSE
Last Name:KAZILIONIS
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:MISS
Other - First Name:HANNAH
Other - Middle Name:ROSE
Other - Last Name:MCCOMISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC, LCSW
Mailing Address - Street 1:257 DEERING AVE # 204
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-4858
Mailing Address - Country:US
Mailing Address - Phone:207-480-3491
Mailing Address - Fax:
Practice Address - Street 1:257 DEERING AVE # 204
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-480-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-09
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6367101YA0400X
MELC171981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)