Individual
SONYA L THERIAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
100 WATERMAN DR, SOUTH PORTLAND, ME 04106-2880
(207) 805-0193
Mailing address
20 FROST HILL RD, PORTLAND, ME 04103-2255
(207) 831-4203
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC17477
ME
Other
Enumeration date
09/19/2018
Last updated
09/19/2018
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