Healthcare Provider Details

I. General information

NPI: 1003061201
Provider Name (Legal Business Name): VALERIE ANNE FELDKAMP CADC, LSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 BUCKSPORT RD
ELLSWORTH ME
04605-2722
US

IV. Provider business mailing address

PO BOX 297
ELLSWORTH ME
04605-0297
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-6890
  • Fax:
Mailing address:
  • Phone: 207-667-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCAC7551
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSX10764
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: