MEDICARE: MAURA SULLIVAN REED LCPC-C

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	101YM0800X	Mental Health Counselor	XL3390	ME

General Provider Information

NPI Number	:	1942452594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURA SULLIVAN REED LCPC-C

Provider Business Mailing Address
First Line	:	67 AGAMENTICUS AVE
Second Line	:
City	:	CAPE NEDDICK
State	:	ME
Zip	:	03902-7109
Country	:	US
Telephone Number	:	207-363-8568
Fax Number	:	207-363-8568

Provider Business Practice Location Address
First Line	:	67 AGAMENTICUS AVE
Second Line	:
City	:	CAPE NEDDICK
State	:	ME
Zip	:	03902-7109
Country	:	US
Telephone Number	:	207-363-8568
Fax Number	:	207-363-8568

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

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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