Individual
JOYCE WIENTZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
17 BISHOP ST, PORTLAND, ME 04103-2659
(207) 871-1235
(207) 879-6161
Mailing address
899 RIVERSIDE ST, PORTLAND, ME 04103-1070
(207) 871-1200
(207) 871-1232
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LC5593
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RB9
ANTHEM
ME
Enumeration date
10/24/2006
Last updated
07/09/2007
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