Healthcare Provider Details

I. General information

NPI: 1164525739
Provider Name (Legal Business Name): SUSAN C MCEWEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN C OLIVARES

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WAVERLY AVE
PITTSFIELD ME
04967
US

IV. Provider business mailing address

PO BOX 66
PITTSFIELD ME
04967
US

V. Phone/Fax

Practice location:
  • Phone: 207-487-2515
  • Fax: 207-487-4961
Mailing address:
  • Phone: 207-487-2515
  • Fax: 207-487-4961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC1227
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: