Provider Demographics
NPI:1982244026
Name:CRONIN, KATHERINE LEE
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LEE
Last Name:CRONIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:LEE
Other - Last Name:MATHIEU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6547
Mailing Address - Country:US
Mailing Address - Phone:207-323-6364
Mailing Address - Fax:
Practice Address - Street 1:321 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEARSPORT
Practice Address - State:ME
Practice Address - Zip Code:04974-3640
Practice Address - Country:US
Practice Address - Phone:207-338-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC183331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical