Provider Demographics
NPI:1043827553
Name:CHAREST, KRISTEN M (LMSW-CC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:CHAREST
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 ELA LN
Mailing Address - Street 2:
Mailing Address - City:FRYEBURG
Mailing Address - State:ME
Mailing Address - Zip Code:04037-1150
Mailing Address - Country:US
Mailing Address - Phone:603-986-3585
Mailing Address - Fax:207-830-8543
Practice Address - Street 1:300 PORTLAND RD STE 1
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4227
Practice Address - Country:US
Practice Address - Phone:207-890-2679
Practice Address - Fax:207-803-8543
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMC19197OtherLMSW-CC