Individual
BENJAMIN TIERNEY-TREVOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
501 DANFORTH STREET, PORTLAND, ME 40101
(207) 294-4400
Mailing address
36 GOUDY ST, SOUTH PORTLAND, ME 04106-4940
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC11115
ME
Other
Enumeration date
02/12/2007
Last updated
07/08/2007
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