Healthcare Provider Details

I. General information

NPI: 1215054804
Provider Name (Legal Business Name): CHERYL J MACLEAN MSW - LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 MARKET ST SUITE 109
FORT KENT ME
04743-1410
US

IV. Provider business mailing address

139 MARKET ST SUITE 109
FORT KENT ME
04743-1410
US

V. Phone/Fax

Practice location:
  • Phone: 207-834-3186
  • Fax: 207-834-7190
Mailing address:
  • Phone: 207-834-3186
  • Fax: 207-834-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC11915
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: