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NPI Code Detail

MEDICARE: KATHERINE D. BALTES L.C.S.W.

MEDICARE: KATHERINE D. BALTES L.C.S.W.
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
11041C0700XClinical Social WorkerLC5649ME

General Provider Information

NPI Number : 1538466552
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE D. BALTES L.C.S.W.
Provider Business Mailing Address
First Line : 25 NEWMAN ST
Second Line :
City : PORTLAND
State : ME
Zip : 04103-1721
Country : US
Telephone Number : 207-797-3816
Fax Number :
Provider Business Practice Location Address
First Line : 9 HASTINGS ST
Second Line :
City : PORTLAND
State : ME
Zip : 04102-2015
Country : US
Telephone Number : 207-232-3759
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2011
Last Update Date : 02/28/2011

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