Individual
HEIDI SISTARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
180 PARK AVE, PORTLAND, ME 04102-2957
(207) 874-2141
Mailing address
215 N MAIN ST, WHITE RIVER JUNCTION, VT 05009-0001
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CAC6285
ME
1041C0700X
Clinical Social Worker
Primary
089.0134405
VT
1041C0700X
Clinical Social Worker
LC17651
ME
Other
Enumeration date
09/22/2017
Last updated
05/12/2022
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