| Doctor Name: | MRS. CONNIE MALENICA |
| NPI Number: | 1083928691 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | LC4028 |
| Business Practice Address: | 108 Pleasant St Fort Kent, ME - 047431576 |
| Business Phone Number: | 2078343481 |
| Business Fax Number: | 2078347357 |
| Mailing Address: | 108 Pleasant St, FORT KENT |
| State: | ME |
| Postal Code: | 047431576 |
| Phone Number: | 2078343481 |
| Fax Number: | 2078347357 |
| NPI Enumeration Date: | 08/06/2010 |
| NPI Last Update Date: | 08/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | LC4028 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |