Individual
KELLY HARTLEY MACKUSICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
980 FOREST AVE STE 207, PORTLAND, ME 04103-3336
(207) 347-6106
(207) 347-6113
Mailing address
175 FORE RIVER PARKWAY, PORTLAND, ME 04102
(207) 879-3526
(207) 879-3553
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC6482
ME
Other
Enumeration date
08/28/2018
Last updated
03/12/2026
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