Individual
KIM MARIE LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
144 HIGH ST, FARMINGTON, ME 04938-1946
(207) 778-0521
Mailing address
19 MARTIN AVE, WATERVILLE, ME 04901-4625
(207) 859-8770
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC2621
ME
Other
Enumeration date
02/09/2007
Last updated
07/08/2007
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