Individual
LINCOLN PAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
735 WILSON ST, BREWER, ME 04412-1000
(079) 891-5672
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
12443784-3501
UT
1041C0700X
Clinical Social Worker
Primary
LC24057
ME
Other
Enumeration date
10/30/2023
Last updated
01/26/2025
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