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General NPI Number Information
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NPI Number | 1740322155
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Entity Type | Individual
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Provider Name | KATHLEEN GRONDIN ST. JAMES LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 19 COMMON ST
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City | SACO
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State | ME
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Zip | 04072-3302
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Country | US
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Telephone | 207-504-1060
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Fax | 866-904-9845
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Provider Business Mailing Address
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Address Line | PO BOX 1728
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City | SACO
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State | ME
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Zip | 04072-7728
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Country | US
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Telephone | 207-504-1060
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Fax | 866-904-9845
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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 | LC5296
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License Number State | ME
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