Individual
MANDIE LASSELLE RISEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
7 OAK HILL TERRACE, SUITE 10, SCARBOROUGH, ME 04074
(207) 756-5425
(207) 874-1044
Mailing address
7 OAK HILL TERRACE, SUITE 10, SCARBOROUGH, ME 04074
(207) 756-5425
(207) 874-1044
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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