Healthcare Provider Details

I. General information

NPI: 1568027399
Provider Name (Legal Business Name): KATRINA M RECORDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 SACO AVE
OLD ORCHARD BEACH ME
04064-1336
US

IV. Provider business mailing address

192 SACO AVE
OLD ORCHARD BEACH ME
04064-1336
US

V. Phone/Fax

Practice location:
  • Phone: 207-613-4777
  • Fax: 207-613-4778
Mailing address:
  • Phone: 207-613-4777
  • Fax: 207-613-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC19004
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC17450
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: