Organization
IRONWOOD MAINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NICOLE ANNE THIBODEAU LMSW-CC (CLINICAL THERAPIST)
(207) 342-3655
Entity
Organization
Contact information
Practice address
67 CAPTAIN CUSHMAN RD, MORRILL, ME 04952-5035
(207) 345-3655
(207) 342-3791
Mailing address
67 CAPTAIN CUSHMAN RD, MORRILL, ME 04952-5035
(207) 345-3655
(207) 342-3791
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MC16161
ME
Other
Enumeration date
10/18/2016
Last updated
10/18/2016
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