Healthcare Provider Details

I. General information

NPI: 1528263191
Provider Name (Legal Business Name): MARY D TOOF LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 BATH RD
BRUNSWICK ME
04011-2609
US

IV. Provider business mailing address

21 LITTLEJOHN RD
CAPE ELIZABETH ME
04107-1805
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC3086
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: