Healthcare Provider Details

I. General information

NPI: 1710991096
Provider Name (Legal Business Name): MARIANNE CAYES BERUBE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 02/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 PORTLAND RD
KENNEBUNK ME
04043-6656
US

IV. Provider business mailing address

58 PORTLAND RD P.O. BOX 1084
KENNEBUNK ME
04043-6656
US

V. Phone/Fax

Practice location:
  • Phone: 207-432-2296
  • Fax: 207-799-9353
Mailing address:
  • Phone: 207-432-2296
  • Fax: 207-799-9353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC11467
License Number StateME

VII. Legacy identifiers

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

# 1
Identifier432258899
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: