Healthcare Provider Details

I. General information

NPI: 1588547855
Provider Name (Legal Business Name): NANCY LEE GNECCO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 VERNON ST STE 2
SACO ME
04072-2723
US

IV. Provider business mailing address

PO BOX 744
DEMOREST GA
30535-0744
US

V. Phone/Fax

Practice location:
  • Phone: 207-604-8366
  • Fax:
Mailing address:
  • Phone: 207-604-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPC229
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: