Individual
KENNETH TEALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
12 UNION ST, ROCKLAND, ME 04841-2739
(207) 701-4477
(207) 701-4486
Mailing address
78 ATLANTIC PL, SOUTH PORTLAND, ME 04106-2316
(207) 842-6556
(207) 842-7773
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LS5311
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431590099
—
ME
Enumeration date
12/21/2006
Last updated
03/05/2010
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