Provider Demographics
NPI:1831201391
Name:KELLEY-COHEN, SHANA JULIET (LCSW)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:JULIET
Last Name:KELLEY-COHEN
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 1:151 N TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3350
Mailing Address - Country:US
Mailing Address - Phone:207-212-6752
Mailing Address - Fax:
Practice Address - Street 1:151 N TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3350
Practice Address - Country:US
Practice Address - Phone:207-212-6752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC8266101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME270610099Medicaid
ME270610099Medicaid