Provider Demographics
NPI:1740364769
Name:RIDEOUT, KATHERINE J (LCSW, MSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:J
Last Name:RIDEOUT
Suffix:
Gender:F
Credentials:LCSW, MSW
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 275
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:ME
Mailing Address - Zip Code:04238-0275
Mailing Address - Country:US
Mailing Address - Phone:207-461-2524
Mailing Address - Fax:
Practice Address - Street 1:HEBRON ACADEMY STUDENT HEALTH CENTER
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:ME
Practice Address - Zip Code:04238
Practice Address - Country:US
Practice Address - Phone:207-461-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5984101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health