Provider Demographics
NPI:1912266578
Name:BATES, KATHARINE (MED)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:ANN
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6666
Mailing Address - Country:US
Mailing Address - Phone:207-872-5300
Mailing Address - Fax:207-680-2142
Practice Address - Street 1:1073 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-3742
Practice Address - Country:US
Practice Address - Phone:207-564-0200
Practice Address - Fax:207-564-0352
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional