Healthcare Provider Details

I. General information

NPI: 1689976599
Provider Name (Legal Business Name): ERICKA DUBOIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MOODY ST
SACO ME
04072-1536
US

IV. Provider business mailing address

PO BOX 1010
SACO ME
04072-1010
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-3000
  • Fax: 207-284-8011
Mailing address:
  • Phone: 207-282-1500
  • Fax: 207-282-7509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC14304
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: