Provider Demographics
NPI:1427346675
Name:KENISTON, DANA A (LCSW)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:A
Last Name:KENISTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 MCLAIN RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:ME
Mailing Address - Zip Code:04949-3715
Mailing Address - Country:US
Mailing Address - Phone:207-462-2264
Mailing Address - Fax:
Practice Address - Street 1:97 MCLAIN RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:ME
Practice Address - Zip Code:04949-3715
Practice Address - Country:US
Practice Address - Phone:207-462-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC142691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical