Basic Information
| Provider Information | |||||||||
| NPI: | 1033444047 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANDRY GRADWELL | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 331 PINE ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042406308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2073449025 | ||||||||
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| Practice Location | |||||||||
| Address1: | 38 FALCON DR | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042104354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077833984 | ||||||||
| FaxNumber: | 2077841358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/08/2009 | ||||||||
| LastUpdateDate: | 03/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC10634 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.