Individual
MANDIE LASSELLE RISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LC9956
ME
1041C0700X
Clinical Social Worker
Primary
LC9956
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267720099
—
ME
Enumeration date
08/31/2006
Last updated
12/20/2011
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