Healthcare Provider Details

I. General information

NPI: 1144499104
Provider Name (Legal Business Name): KATHERINE EILEEN MARBLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 03/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 RODMAN RD
AUBURN ME
04210-3830
US

IV. Provider business mailing address

PO BOX 1150
AUBURN ME
04211-1150
US

V. Phone/Fax

Practice location:
  • Phone: 207-333-3833
  • Fax: 207-333-6939
Mailing address:
  • Phone: 207-333-3278
  • Fax: 207-333-3037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC11119
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC12147
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: