Healthcare Provider Details

I. General information

NPI: 1215125802
Provider Name (Legal Business Name): KATHERINE AMES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 W MAIN ST
WALDOBORO ME
04572-6030
US

IV. Provider business mailing address

592 W MAIN ST
WALDOBORO ME
04572-6030
US

V. Phone/Fax

Practice location:
  • Phone: 207-832-6394
  • Fax: 207-832-4392
Mailing address:
  • Phone: 207-832-6394
  • Fax: 207-832-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC12505
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: