Individual
SHAWN D THERIAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
1155 LISBON ST, LEWISTON, ME 04241
(207) 783-9141
(207) 783-4660
Mailing address
584 MAIN ST, APT 4, LEWISTON, ME 04240
(207) 316-8466
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
09/15/2006
Last updated
07/08/2007
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