Healthcare Provider Details

I. General information

NPI: 1912018409
Provider Name (Legal Business Name): CATHERINE DELIA COOMBS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ASH ST
FARMINGDALE ME
04344-1639
US

IV. Provider business mailing address

22 ASH ST
FARMINGDALE ME
04344-1639
US

V. Phone/Fax

Practice location:
  • Phone: 207-441-8656
  • Fax: 207-621-2320
Mailing address:
  • Phone: 207-441-8656
  • Fax: 207-621-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC6299
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: