Provider Demographics
NPI:1740322155
Name:ST. JAMES, KATHLEEN GRONDIN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:GRONDIN
Last Name:ST. JAMES
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:PO BOX 1728
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-7728
Mailing Address - Country:US
Mailing Address - Phone:207-504-1060
Mailing Address - Fax:866-904-9845
Practice Address - Street 1:19 COMMON ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3302
Practice Address - Country:US
Practice Address - Phone:207-504-1060
Practice Address - Fax:866-904-9845
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC52961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1740322155Medicaid
ME$$$$$$$$$OtherAETNA
MM915402Medicare UPIN
MEMM915402Medicare Oscar/Certification
ME$$$$$$$$$OtherAETNA