Healthcare Provider Details

I. General information

NPI: 1093606733
Provider Name (Legal Business Name): KATIE MAHON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date: 06/09/2026
Reactivation Date: 07/20/2026

III. Provider practice location address

268 STILLWATER AVE
BANGOR ME
04401-3980
US

IV. Provider business mailing address

134 UNION ST
BREWER ME
04412-2037
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-6100
  • Fax:
Mailing address:
  • Phone: 978-879-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC26112
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC6539
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: