Individual
STACY MARISSA FARESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
314 ALFRED ST, BIDDEFORD, ME 04005-3102
(207) 216-2637
Mailing address
PO BOX 186, WELLS, ME 04090-0186
(207) 370-2483
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC5472
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y10400
MEDICARE PTAN Y10400
MA
Enumeration date
09/23/2015
Last updated
11/10/2020
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