Provider Demographics
NPI:1801325147
Name:SHATTO, GWENDOLYN (LCPC)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:SHATTO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH
Mailing Address - State:ME
Mailing Address - Zip Code:04579-4203
Mailing Address - Country:US
Mailing Address - Phone:207-208-9166
Mailing Address - Fax:
Practice Address - Street 1:72 FRONT ST STE 9
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2657
Practice Address - Country:US
Practice Address - Phone:207-208-9193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health