Healthcare Provider Details

I. General information

NPI: 1871456293
Provider Name (Legal Business Name): LARA ANDERSON LMSWCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 LINCOLN ST
PORTLAND ME
04103-4052
US

IV. Provider business mailing address

96 LINCOLN ST APT 3
PORTLAND ME
04103-4052
US

V. Phone/Fax

Practice location:
  • Phone: 207-841-5902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberMC24955
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: