Healthcare Provider Details

I. General information

NPI: 1376708941
Provider Name (Legal Business Name): GWEN ENID OWEN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MAIN ST
BIDDEFORD ME
04005-2411
US

IV. Provider business mailing address

235 MAIN ST
BIDDEFORD ME
04005-2411
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-7660
  • Fax: 207-283-7664
Mailing address:
  • Phone: 207-283-7660
  • Fax: 207-283-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number113175
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC10129
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: