Healthcare Provider Details

I. General information

NPI: 1154341139
Provider Name (Legal Business Name): DEBORAH L DAIGLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBORAH L LONG LCSW

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SCHOOL ST SUITE 1
ALBION ME
04910-6501
US

IV. Provider business mailing address

69 DOCKSIDE LN
BELFAST ME
04915-6090
US

V. Phone/Fax

Practice location:
  • Phone: 207-437-9388
  • Fax: 207-437-2557
Mailing address:
  • Phone: 207-436-1630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC11641
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierLC11641
Identifier TypeOTHER
Identifier StateME
Identifier IssuerSTATE OF MAINE, LICENSED CLINICAL SOCIAL WORKER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: