Healthcare Provider Details

I. General information

NPI: 1902137045
Provider Name (Legal Business Name): DENISE JOAN BOISSE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2010
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 CLARKS MILL RD
HOLLIS CENTER ME
04042-3850
US

IV. Provider business mailing address

174 CLARKS MILL RD
HOLLIS CENTER ME
04042-3850
US

V. Phone/Fax

Practice location:
  • Phone: 120-724-7289
  • Fax:
Mailing address:
  • Phone: 120-724-7289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103K00000X
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: