| Doctor Name: | KRISTIN THERIAULT |
| NPI Number: | 1679944490 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | MC15640 |
| Business Practice Address: | 358 Hamlin Rd Hamlin, ME - 04785 |
| Business Phone Number: | 2075512552 |
| Business Fax Number: | |
| Mailing Address: | 358 Hamlin Rd, HAMLIN |
| State: | ME |
| Postal Code: | 04785 |
| Phone Number: | 2075512552 |
| Fax Number: | |
| NPI Enumeration Date: | 10/20/2015 |
| NPI Last Update Date: | 10/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | MC15640 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |