Provider Demographics
NPI:1801371372
Name:SHAW, KASSIDIE F (CADC)
Entity type:Individual
Prefix:
First Name:KASSIDIE
Middle Name:F
Last Name:SHAW
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:KASSIDIE
Other - Middle Name:F
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 ACADEMY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3183
Mailing Address - Country:US
Mailing Address - Phone:207-554-2352
Mailing Address - Fax:207-554-2351
Practice Address - Street 1:43 HATCH DR STE 310
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2039
Practice Address - Country:US
Practice Address - Phone:207-493-2336
Practice Address - Fax:207-492-4889
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MECAC8174101Y00000X
MECAC6711101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor