Healthcare Provider Details

I. General information

NPI: 1477466712
Provider Name (Legal Business Name): ELIZABETH SIMON-MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 WHITTEN RD
HALLOWELL ME
04347-3057
US

IV. Provider business mailing address

95 COLUMBIA AVE
BRUNSWICK ME
04011-2903
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-6760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC25171
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: