Healthcare Provider Details

I. General information

NPI: 1205010717
Provider Name (Legal Business Name): LOIDA ELENA BICERA RUANE LMSW-CC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 01/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SUMMER ST
BANGOR ME
04401-6446
US

IV. Provider business mailing address

110 BILLINGS RD
HERMON ME
04401-0534
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-4240
  • Fax: 207-299-1116
Mailing address:
  • Phone: 207-848-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC11402
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: