Individual
MRS. MICHELE ANN MATHIEU BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW-C
Contact information
Practice address
9 HILLCREST AVENUE, RANDOLPH, ME 04346
(207) 582-9205
(207) 582-9653
Mailing address
899 RIVERSIDE STREET, PORTLAND, ME 04103
(207) 871-1211
(207) 871-1232
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSX13488
ME
Other
Enumeration date
08/31/2012
Last updated
08/31/2012
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