Provider Demographics
NPI:1427113810
Name:CROOM, KELLY (MED, LCPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:CROOM
Suffix:
Gender:F
Credentials:MED, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2876
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-2876
Mailing Address - Country:US
Mailing Address - Phone:207-944-4090
Mailing Address - Fax:
Practice Address - Street 1:60 FRONT ST
Practice Address - Street 2:SUITE 10
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6658
Practice Address - Country:US
Practice Address - Phone:207-944-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3489101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional