Provider Demographics
NPI:1518850312
Name:MACCOLL, KATHERINE LOUISE (LCSW)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LOUISE
Last Name:MACCOLL
Suffix:
Gender:X
Credentials:LCSW
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:MACCOLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8484
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-8484
Mailing Address - Country:US
Mailing Address - Phone:207-619-3356
Mailing Address - Fax:207-300-6085
Practice Address - Street 1:30 DANFORTH ST STE 311
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4574
Practice Address - Country:US
Practice Address - Phone:207-619-3356
Practice Address - Fax:207-300-6085
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC247311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical