MEDICARE: KATHERINE P WHITTEMORE LCPC-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1003509456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE P WHITTEMORE LCPC-C

Provider Business Mailing Address
First Line	:	86 DAVIS ST
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-4908
Country	:	US
Telephone Number	:	207-242-0443
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 FOREST AVE
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-3300
Country	:	US
Telephone Number	:	207-242-0443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	05/31/2023

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