Provider Demographics
NPI:1043258882
Name:DAVIS, KATHERINE M (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 COLUMBIA ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6346
Mailing Address - Country:US
Mailing Address - Phone:207-941-8829
Mailing Address - Fax:207-825-3827
Practice Address - Street 1:43 COLUMBIA ST
Practice Address - Street 2:SUITE 11
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6346
Practice Address - Country:US
Practice Address - Phone:207-941-8829
Practice Address - Fax:207-825-3827
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7675142OtherAETNA
ME11255707OtherCAQH
ME037459OtherANTHEM BLUE CROSS
MEMM9339Medicare ID - Type Unspecified