Healthcare Provider Details

I. General information

NPI: 1568191740
Provider Name (Legal Business Name): KATHERINE RODNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WASHINGTON AVE STE 100
PORTLAND ME
04103-2842
US

IV. Provider business mailing address

113 CROSBY RD STE 1
DOVER NH
03820-4370
US

V. Phone/Fax

Practice location:
  • Phone: 207-871-1200
  • Fax:
Mailing address:
  • Phone: 603-516-9300
  • Fax: 603-740-9179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLC21697
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: