Provider Demographics
NPI:1033444047
Name:LANDRY GRADWELL, KATHRYN (LCSW)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:LANDRY GRADWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 PINE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6308
Mailing Address - Country:US
Mailing Address - Phone:207-344-9025
Mailing Address - Fax:
Practice Address - Street 1:38 FALCON DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4354
Practice Address - Country:US
Practice Address - Phone:207-783-3984
Practice Address - Fax:207-784-1358
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC106341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical