Provider Demographics
NPI:1174996185
Name:KIRKILAS, ELISE C (LCSW)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:C
Last Name:KIRKILAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:C
Other - Last Name:KAPITANCEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 ANCHOR DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-3848
Mailing Address - Country:US
Mailing Address - Phone:207-301-5800
Mailing Address - Fax:207-301-5332
Practice Address - Street 1:15 ANCHOR DR STE 202
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-3848
Practice Address - Country:US
Practice Address - Phone:207-301-5800
Practice Address - Fax:207-301-5332
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH29341041C0700X
COCSW.099286681041C0700X
WI10098-1231041C0700X
AK1693661041C0700X
MELC218581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical