=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073577334
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE KAZAN-KOMAREK LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 997 MAIN ST
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-324-4777
-----------------------------------------------------
Fax | 207-324-3655
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 37 FOXCROFT LN
-----------------------------------------------------
City | ARUNDEL
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-985-9430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | MC4818
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------