Healthcare Provider Details

I. General information

NPI: 1124427174
Provider Name (Legal Business Name): EMMA GARRITY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA TRIPP LMSW-CC

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 SABATTUS ST
LEWISTON ME
04240-4120
US

IV. Provider business mailing address

901 WASHINGTON AVE STE 100
PORTLAND ME
04103-2842
US

V. Phone/Fax

Practice location:
  • Phone: 207-871-1211
  • Fax:
Mailing address:
  • Phone: 207-871-1200
  • Fax: 207-871-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLC16766
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: