Individual
SUZANNE E LABERGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
203 ANDERSON STREET, STE 3, PORTLAND, ME 04401
(207) 874-6787
Mailing address
203 ANDERSON STREET, STE 3, PORTLAND, ME 04401
(207) 874-6787
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
CC863
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
044582
ANTHEM
ME
05
—
21945000
—
ME
Enumeration date
08/30/2006
Last updated
07/08/2007
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