Individual
IVELISSE SLAVEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1 VA CTR, AUGUSTA, ME 04330-6795
(207) 623-8411
Mailing address
1 VA CTR, AUGUSTA, ME 04330-6795
(207) 623-8411
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LC8692
ME
1041C0700X
Clinical Social Worker
Primary
LC8692
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098304
ANTHEM LEGACY NUMBER
ME
05
—
294220099
—
ME
Enumeration date
05/30/2006
Last updated
08/25/2020
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