Healthcare Provider Details

I. General information

NPI: 1033329263
Provider Name (Legal Business Name): LAUREL SNOW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CUSHING BRIGGS RD
FREEPORT ME
04032-6140
US

IV. Provider business mailing address

2 CUSHING BRIGGS RD
FREEPORT ME
04032-6140
US

V. Phone/Fax

Practice location:
  • Phone: 207-865-9420
  • Fax: 207-865-9420
Mailing address:
  • Phone: 207-865-9420
  • Fax: 207-865-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC11081
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: