Individual
MS. CYNTHIA MICHELLE PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
15 STATE ST STE 305, BANGOR, ME 04401-5166
(207) 217-2434
Mailing address
15 STATE ST STE 305, BANGOR, ME 04401-5166
(207) 217-2434
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC11171
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710392956
—
ME
Enumeration date
06/26/2014
Last updated
11/11/2014
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