Doctor Name: | PATRICIA V KELLEHER |
NPI Number: | 1306030457 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA,LCPC,CADC,CCS |
License Number: | CC2066 |
Business Practice Address: | 59 River St Dover Foxcroft, ME - 044262300 |
Business Phone Number: | 2075647106 |
Business Fax Number: | 2075640881 |
Mailing Address: | Po Box 380, DOVER FOXCROFT |
State: | ME |
Postal Code: | 044260380 |
Phone Number: | 2075642464 |
Fax Number: | 2075642404 |
NPI Enumeration Date: | 08/31/2007 |
NPI Last Update Date: | 08/31/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | CC2066 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |