Individual
CHARISSA ROSE FORTIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, BCBA
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-16-21527
ME
1041C0700X
Clinical Social Worker
Primary
LC13584
ME
1041C0700X
Clinical Social Worker
Primary
MC12608
ME
Other
Enumeration date
11/22/2011
Last updated
08/19/2026
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