Individual
KAISA MANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
30 DANFORTH ST STE 311, PORTLAND, ME 04101-4574
(207) 619-3356
(207) 300-6085
Mailing address
PO BOX 8484, PORTLAND, ME 04104-8484
(207) 619-3356
(207) 300-6085
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC5988
ME
1041C0700X
Clinical Social Worker
Primary
LC17730
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164484093
—
ME
Enumeration date
04/15/2015
Last updated
07/18/2024
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