MEDICARE: DIANE KEUBLER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC5650	ME

General Provider Information

NPI Number	:	1124352406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE KEUBLER LCSW

Provider Business Mailing Address
First Line	:	10 ALPS RD
Second Line	:
City	:	STOCKTON SPRINGS
State	:	ME
Zip	:	04981-4316
Country	:	US
Telephone Number	:	207-322-7800
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 ALPS RD
Second Line	:
City	:	STOCKTON SPRINGS
State	:	ME
Zip	:	04981-4316
Country	:	US
Telephone Number	:	207-322-7800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2009
Last Update Date	:	09/20/2009

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