Individual
ANDREA ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14 MAINE ST # 54, BRUNSWICK, ME 04011-2049
(800) 434-3000
Mailing address
14 MAINE ST # 54, BRUNSWICK, ME 04011-2049
(800) 434-3000
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC12363
ME
Other
Enumeration date
01/21/2010
Last updated
06/13/2011
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