Healthcare Provider Details

I. General information

NPI: 1144731209
Provider Name (Legal Business Name): KELSEY SNAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 02/10/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CONGRESS ST
PORTLAND ME
04101-3515
US

IV. Provider business mailing address

400 CONGRESS ST
PORTLAND ME
04101-3515
US

V. Phone/Fax

Practice location:
  • Phone: 323-205-7088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC17823
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: