MEDICARE: KATHERINE ELIZABETH BOX LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LSX9781	ME
2	104100000X	Social Worker	LC13400	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063570950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ELIZABETH BOX LCSW

Provider Business Mailing Address
First Line	:	1295 ATLANTIC HWY
Second Line	:
City	:	NORTHPORT
State	:	ME
Zip	:	04849-3600
Country	:	US
Telephone Number	:	207-470-7090
Fax Number	:	207-470-7094

Provider Business Practice Location Address
First Line	:	1295 ATLANTIC HWY.
Second Line	:
City	:	NORTHPORT
State	:	ME
Zip	:	04849-3600
Country	:	US
Telephone Number	:	207-470-7090
Fax Number	:	207-470-7094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	03/01/2012

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