Healthcare Provider Details

I. General information

NPI: 1265528392
Provider Name (Legal Business Name): AMIE LYN HASHAM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMIE LYN QUIRION CCS

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 CHRISTIAN RIDGE RD
ELLSWORTH ME
04605-2116
US

IV. Provider business mailing address

52 CHRISTIAN RIDGE RD
ELLSWORTH ME
04605-2116
US

V. Phone/Fax

Practice location:
  • Phone: 207-667-5357
  • Fax: 207-288-7024
Mailing address:
  • Phone: 207-667-5357
  • Fax: 207-288-7024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC10709
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: