Healthcare Provider Details

I. General information

NPI: 1518484898
Provider Name (Legal Business Name): DENISE M THORN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE M ANDERSON

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS AVE STE A&B
LEWISTON ME
04240
US

IV. Provider business mailing address

PO BOX 7291
LEWISTON ME
04243-7291
US

V. Phone/Fax

Practice location:
  • Phone: 207-755-3434
  • Fax: 207-784-6826
Mailing address:
  • Phone: 207-777-8553
  • Fax: 207-777-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC15756
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC15756
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: