Individual
MS. SUZANNE T. HUMPHRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1093 W MAIN ST, DOVER FOXCROFT, ME 04426-3717
(207) 564-8175
Mailing address
8 OAKES MANOR RD, SANGERVILLE, ME 04479-3101
(207) 650-3987
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC6751
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11803859
CAQH PROVIDER ID
ME
05
—
256740099
—
ME
Enumeration date
04/26/2007
Last updated
08/06/2014
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