Individual
RISA MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
609 FOREST AVE, 2ND FLOOR, PORTLAND, ME 04101-1515
(207) 712-4031
(207) 657-7861
Mailing address
609 FOREST AVE, 2ND FLOOR, PORTLAND, ME 04101-1515
(207) 712-4031
(207) 657-7861
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC9746
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
079202
ANTHEM BLUECROSS BLUE SHI
ME
01
—
58787129
UBH
ME
Enumeration date
02/07/2007
Last updated
07/08/2007
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