Healthcare Provider Details

I. General information

NPI: 1003659632
Provider Name (Legal Business Name): SABRINA DUONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MIDDLE JAM RD
GORHAM ME
04038-2463
US

IV. Provider business mailing address

8 MIDDLE JAM RD
GORHAM ME
04038-2463
US

V. Phone/Fax

Practice location:
  • Phone: 626-884-3484
  • Fax:
Mailing address:
  • Phone: 207-572-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC23305
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: