Provider Demographics
NPI:1174149793
Name:TRUE, KATHLEEN DERRIG (LCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DERRIG
Last Name:TRUE
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 1:123 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3850
Mailing Address - Country:US
Mailing Address - Phone:207-761-2200
Mailing Address - Fax:
Practice Address - Street 1:22 W COLE RD STE 103
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9431
Practice Address - Country:US
Practice Address - Phone:207-571-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-19
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC184931041C0700X
MELC219771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical