Healthcare Provider Details

I. General information

NPI: 1801305362
Provider Name (Legal Business Name): ANDREA B CRAIG DUPLISEA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 PALMER ST
CALAIS ME
04619-1300
US

IV. Provider business mailing address

127 PALMER ST
CALAIS ME
04619-1300
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-0270
  • Fax: 207-454-0775
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC16916
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: