Individual
MARIE ANN ILVONEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12 UNION ST, ROCKLAND, ME 04841-2739
(207) 701-4477
(207) 701-4486
Mailing address
78 ATLANTIC PL, SOUTH PORTLAND, ME 04106-2316
(207) 842-6556
(207) 842-7773
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC3119
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104540000
—
ME
05
—
208130099
—
ME
Enumeration date
02/19/2008
Last updated
11/02/2010
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