Healthcare Provider Details

I. General information

NPI: 1346503588
Provider Name (Legal Business Name): CATHERINE M KOBELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 BRACKETT ST
PORTLAND ME
04102-3857
US

IV. Provider business mailing address

181 BRACKETT ST
PORTLAND ME
04102-3857
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-0105
  • Fax: 207-775-1392
Mailing address:
  • Phone: 207-775-0105
  • Fax: 207-775-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC2178
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: