Healthcare Provider Details

I. General information

NPI: 1336066521
Provider Name (Legal Business Name): TEAGAN MARIE BLACKIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 ENFIELD RD
LINCOLN ME
04457-1175
US

IV. Provider business mailing address

11 SEWALL DR
OLD TOWN ME
04468-1222
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-3133
  • Fax:
Mailing address:
  • Phone: 207-794-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC26101
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: