Individual
STACEY M. OUELLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9 HEALTHCARE DR STE 204, BIDDEFORD, ME 04005-9450
(207) 284-2630
Mailing address
78 ATLANTIC PLACE, SOUTH PORTLAND, ME 04106-2316
(207) 842-7700
(207) 842-7773
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC11307
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431955199
—
ME
Enumeration date
08/15/2006
Last updated
10/22/2019
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