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General NPI Number Information
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NPI Number | 1134652589
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Entity Type | Individual
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Provider Name | NOAH DANIEL KRELL LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 57 EXCHANGE ST STE 203
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City | PORTLAND
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State | ME
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Zip | 04101-5000
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Country | US
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Telephone | 207-417-6260
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Fax | 207-569-9919
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Provider Business Mailing Address
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Address Line | 19 WESTMINSTER AVE
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City | PORTLAND
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State | ME
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Zip | 04103-2430
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Country | US
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Telephone | 207-417-6260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC18201
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License Number State | ME
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