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General NPI Number Information
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NPI Number | 1538466552
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Entity Type | Individual
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Provider Name | KATHERINE D. BALTES L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 02/28/2011
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Last Update Date | 02/28/2011
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Provider Practice Location Address
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Address Line | 9 HASTINGS ST
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City | PORTLAND
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State | ME
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Zip | 04102-2015
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Country | US
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Telephone | 207-232-3759
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Fax |
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Provider Business Mailing Address
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Address Line | 25 NEWMAN ST
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City | PORTLAND
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State | ME
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Zip | 04103-1721
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Country | US
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Telephone | 207-797-3816
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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 | LC5649
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License Number State | ME
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