Healthcare Provider Details

I. General information

NPI: 1932340684
Provider Name (Legal Business Name): CHRISTINE SUSAN HUFNAGEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 BATES ST
LEWISTON ME
04240-7330
US

IV. Provider business mailing address

PO BOX 164
WEST FARMINGTON ME
04992-0164
US

V. Phone/Fax

Practice location:
  • Phone: 207-645-8000
  • Fax: 207-783-7489
Mailing address:
  • Phone: 207-645-8000
  • Fax: 207-783-7489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC10034
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: