Individual
MR. KENNETH P MATHEWSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT, LADC
Contact information
Practice address
781 NORTH RD, MEDFORD, ME 04463-6123
(860) 305-9249
Mailing address
781 NORTH RD, MEDFORD, ME 04463-6123
(860) 305-9249
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
000746
CT
106H00000X
Marriage & Family Therapist
001026
CT
106H00000X
Marriage & Family Therapist
Primary
MF4145
ME
Other
Enumeration date
03/10/2007
Last updated
05/29/2013
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