Healthcare Provider Details

I. General information

NPI: 1396653184
Provider Name (Legal Business Name): KASSI M MANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 CAMPUS AVE
LEWISTON ME
04240-5401
US

IV. Provider business mailing address

115 CAMPUS AVE
LEWISTON ME
04240-5401
US

V. Phone/Fax

Practice location:
  • Phone: 207-745-3562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC7843
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: