Healthcare Provider Details

I. General information

NPI: 1598719692
Provider Name (Legal Business Name): LAURIE E LAVIOLETTE LCSW,CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 STATE ST
ELLSWORTH ME
04605-1923
US

IV. Provider business mailing address

201 RICHARDSON RD
ORRINGTON ME
04474-3924
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-9101
  • Fax: 866-706-0381
Mailing address:
  • Phone: 207-852-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCCS3850
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC5721
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: