Healthcare Provider Details

I. General information

NPI: 1235017815
Provider Name (Legal Business Name): KATHRYN M VANDERMAST LMSW-CC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 MALLISON FALLS RD
WINDHAM ME
04062-4101
US

IV. Provider business mailing address

9 CODMAN ST
PORTLAND ME
04103-4527
US

V. Phone/Fax

Practice location:
  • Phone: 207-893-7000
  • Fax:
Mailing address:
  • Phone: 303-817-7901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC25144
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: