Provider Demographics
NPI:1801689500
Name:MCCONNELL, KATHARINE HUMAIRA RUTH (LMSW-CC)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:HUMAIRA RUTH
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:MICKEY
Other - Middle Name:
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW-CC
Mailing Address - Street 1:491 US ROUTE 1 STE 23
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-7022
Mailing Address - Country:US
Mailing Address - Phone:207-200-1675
Mailing Address - Fax:207-544-5070
Practice Address - Street 1:491 US ROUTE 1 STE 23
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-7022
Practice Address - Country:US
Practice Address - Phone:207-200-1675
Practice Address - Fax:207-544-5070
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC247681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical