Individual
MARY CAROL KENNEDY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCSW, CCS, LADC
Contact information
Practice address
23 WATER ST, SUITE 7, SACO, ME 04072-5119
(207) 284-1173
Mailing address
4 SCAMMON ST, SUITE 19-181, SACO, ME 04072-5121
(207) 284-1173
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC3972
ME
1041C0700X
Clinical Social Worker
Primary
LC4943
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200938
ANTHEM
ME
Enumeration date
01/14/2008
Last updated
05/22/2008
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