Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | CAC5573 | ME |
NPI | 1003202110 |
---|---|
Provider Name | Kristen Cianelli |
First Address | South Portland, ME 04106-5457 |
Second Address | South Portland, ME 04106-5457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 15/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164484093 | (05) | ME |