Provider Demographics
NPI:1104982941
Name:DIMARZIO, CATHLEEN M (LCPC)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:M
Last Name:DIMARZIO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:CATE
Other - Middle Name:
Other - Last Name:DIMARZIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:325 MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-7948
Mailing Address - Country:US
Mailing Address - Phone:207-846-1008
Mailing Address - Fax:
Practice Address - Street 1:325 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-7948
Practice Address - Country:US
Practice Address - Phone:207-846-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1966101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
098484OtherANTHEM
11624082OtherCAQH
ME262870099Medicaid