Provider Demographics
NPI:1194811653
Name:KELSIK, SARAH E (LCSW)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:E
Last Name:KELSIK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 RUSTIC LANE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103
Mailing Address - Country:US
Mailing Address - Phone:207-332-3177
Mailing Address - Fax:207-878-6150
Practice Address - Street 1:7 OAK HILL TERRACE
Practice Address - Street 2:SUITE 10
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-332-3177
Practice Address - Fax:207-878-6150
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6543101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME319470099Medicaid
MEME0318Medicare ID - Type Unspecified