Individual
KATIE JANESSA TYLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
18 MEADOW RD, AUGUSTA, ME 04330-4915
(207) 441-4482
Mailing address
PO BOX 5641, AUGUSTA, ME 04332-5641
(207) 623-1898
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
MC16433
ME
Other
Enumeration date
05/17/2017
Last updated
03/30/2022
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