Provider Demographics
NPI:1154708048
Name:POITRAS, KATHLEEN R (MHRT-C, LSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:POITRAS
Suffix:
Gender:F
Credentials:MHRT-C, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SWEDEN ST
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2127
Mailing Address - Country:US
Mailing Address - Phone:207-493-3316
Mailing Address - Fax:207-492-4889
Practice Address - Street 1:24 SWEDEN ST
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2127
Practice Address - Country:US
Practice Address - Phone:207-493-3316
Practice Address - Fax:207-492-4889
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1154708048Medicaid