Provider Demographics
NPI:1053343897
Name:KIENZLE, JANICE L (LCPC)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:L
Last Name:KIENZLE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:JANICE
Other - Middle Name:L
Other - Last Name:KIENZLE-PAPPALARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:884 BROADWAY STE 13
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-4371
Mailing Address - Country:US
Mailing Address - Phone:207-747-8242
Mailing Address - Fax:
Practice Address - Street 1:884 BROADWAY STE 13
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-4371
Practice Address - Country:US
Practice Address - Phone:207-747-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002856101YP2500X
MECC4433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional