Healthcare Provider Details

I. General information

NPI: 1639470974
Provider Name (Legal Business Name): AMY L RANCO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LIBBY HILL RD GRAY NEW GLOUCESTER HIGH SCHOOL
GRAY ME
04039-9712
US

IV. Provider business mailing address

21 MAYFIELD DR
WESTBROOK ME
04092-2534
US

V. Phone/Fax

Practice location:
  • Phone: 207-657-2066
  • Fax:
Mailing address:
  • Phone: 207-854-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC6531
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: