Individual
MARY LAVINA FREDRICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
38 UNION ST, LIVERMORE FALLS, ME 04254
(207) 897-6601
(207) 897-4339
Mailing address
38 UNION ST, LIVERMORE FALLS, ME 04254
(207) 897-6601
(207) 897-4339
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ME129365
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
047005
ANTHEM
ME
05
—
218840099
—
ME
Enumeration date
03/08/2006
Last updated
11/15/2012
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