Healthcare Provider Details

I. General information

NPI: 1205624285
Provider Name (Legal Business Name): KASANDRA DUMONT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

396 GRIFFIN RD UNIT 106
BANGOR ME
04401-3023
US

IV. Provider business mailing address

396 GRIFFIN RD UNIT 106
BANGOR ME
04401-3023
US

V. Phone/Fax

Practice location:
  • Phone: 207-573-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88913
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: