Healthcare Provider Details

I. General information

NPI: 1073638037
Provider Name (Legal Business Name): SEANNA MARIE MACOMBER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 ILLINOIS AVE
BANGOR ME
04401-2722
US

IV. Provider business mailing address

739 PLEASANT ST
BLUE HILL ME
04614-5606
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-4240
  • Fax:
Mailing address:
  • Phone: 207-266-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC5276
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC11461
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: