1770883399 NPI number — MRS. KRISTEN KATHLEEN BENNETT LMSWCC

Table of content: MRS. KRISTEN KATHLEEN BENNETT LMSWCC (NPI 1770883399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770883399 NPI number — MRS. KRISTEN KATHLEEN BENNETT LMSWCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENNETT
Provider First Name:
KRISTEN
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSWCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHISHOLM
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSWCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770883399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
WESTBROOK
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04092-4761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-210-3930
Provider Business Mailing Address Fax Number:
208-887-7130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
WESTBROOK
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04092-4761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-210-3931
Provider Business Practice Location Address Fax Number:
207-887-7130
Provider Enumeration Date:
10/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  12686 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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