Healthcare Provider Details

I. General information

NPI: 1174067003
Provider Name (Legal Business Name): SHEILA WORSAA MS, LCPC-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 12/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 CEDAR STREET
BANGOR ME
04402-0425
US

IV. Provider business mailing address

128 WEST BROADWAY
BANGOR ME
04401
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-0366
  • Fax: 207-942-4360
Mailing address:
  • Phone: 207-922-4462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberXL4694
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: