Provider Demographics
NPI:1285843326
Name:KIRKPATRICK-CLARKE, SHIRLEY ANN (LCPC)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:ANN
Last Name:KIRKPATRICK-CLARKE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 MILO RD
Mailing Address - Street 2:
Mailing Address - City:SEBEC
Mailing Address - State:ME
Mailing Address - Zip Code:04481-3245
Mailing Address - Country:US
Mailing Address - Phone:207-717-2121
Mailing Address - Fax:
Practice Address - Street 1:63 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1135
Practice Address - Country:US
Practice Address - Phone:207-564-6535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME334120099Medicaid