Basic Information
| Provider Information | |||||||||
| NPI: | 1033549357 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARVEY | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1604 BENTON AVE | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049013327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074534708 | ||||||||
| FaxNumber: | 2072386302 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 MT BLUE CIR | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049386276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076604549 | ||||||||
| FaxNumber: | 2076604529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2013 | ||||||||
| LastUpdateDate: | 06/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC18476 | ME | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.