Individual
THERESA PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
92 DEERING AVE, PORTLAND, ME 04102-2901
(207) 874-8104
(207) 874-8290
Mailing address
92 DEERING AVE, PORTLAND, ME 04102-2901
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LM1043
ME
Other
Enumeration date
04/13/2011
Last updated
04/13/2011
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