Individual
JUDITH L ENTWISTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
15 HOLLY ST, SCARBOROUGH, ME 04074-8867
(207) 396-5335
Mailing address
18 SMITHWHEEL RD APT 5, OLD ORCHARD BEACH, ME 04064-1035
(207) 934-0563
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC6250
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251270099
—
ME
Enumeration date
07/31/2006
Last updated
10/01/2008
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