Healthcare Provider Details

I. General information

NPI: 1386959401
Provider Name (Legal Business Name): LOIS KATHLEEN GROSVENOR MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 BENNETT HILL RD
EAST WATERBORO ME
04030-5307
US

IV. Provider business mailing address

802 MAIN ST.
WATERBORO ME
04087
US

V. Phone/Fax

Practice location:
  • Phone: 207-247-9000
  • Fax: 207-247-6109
Mailing address:
  • Phone: 207-247-9000
  • Fax: 207-247-6109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC9414
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: