Provider Demographics
NPI:1760841092
Name:BARON, KATIE LYNN (LCPCC)
Entity type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:LYNN
Last Name:BARON
Suffix:
Gender:F
Credentials:LCPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 UPPER DEDHAM RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429-7503
Mailing Address - Country:US
Mailing Address - Phone:207-731-1171
Mailing Address - Fax:
Practice Address - Street 1:30 SUMMER ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6467
Practice Address - Country:US
Practice Address - Phone:207-561-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health