Healthcare Provider Details

I. General information

NPI: 1679180889
Provider Name (Legal Business Name): LAURIE A SPATARO LMHC, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURIE A BROWN

II. Dates (important events)

Enumeration Date: 09/30/2020
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 CHURCH HILL RD
AUGUSTA ME
04330-8218
US

IV. Provider business mailing address

855 CHURCH HILL RD
AUGUSTA ME
04330-8218
US

V. Phone/Fax

Practice location:
  • Phone: 561-713-8511
  • Fax:
Mailing address:
  • Phone: 561-713-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC7124
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLC7124
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number20966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: