Healthcare Provider Details

I. General information

NPI: 1790061190
Provider Name (Legal Business Name): ROBIN ELIZABETH DEATRICH LMSW., CH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. ROBIN ELIZABETH ABRAMOWITH

II. Dates (important events)

Enumeration Date: 10/30/2011
Last Update Date: 10/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 FARWELL ST
LISBON ME
04250-6824
US

IV. Provider business mailing address

88 LITTLEFIELD RD
LISBON ME
04250-6009
US

V. Phone/Fax

Practice location:
  • Phone: 207-353-8118
  • Fax:
Mailing address:
  • Phone: 207-740-7477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLM12840
License Number StateME

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: