Provider Demographics
NPI:1770742504
Name:ECKERT, KATHRYN LOUISE I (LMSW-CC)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LOUISE
Last Name:ECKERT
Suffix:I
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 1:94 HOLYOKE ST
Mailing Address - Street 2:APT. C
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1964
Mailing Address - Country:US
Mailing Address - Phone:207-989-6708
Mailing Address - Fax:
Practice Address - Street 1:40 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04402-0936
Practice Address - Country:US
Practice Address - Phone:207-945-4240
Practice Address - Fax:207-990-3660
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC115771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical