Healthcare Provider Details

I. General information

NPI: 1285057463
Provider Name (Legal Business Name): CHELSEA C SPEAR LMFT-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MOODY ST SWEETSER
SACO ME
04072-1536
US

IV. Provider business mailing address

50 MOODY ST SWEETSER
SACO ME
04072-1536
US

V. Phone/Fax

Practice location:
  • Phone: 800-434-3000
  • Fax:
Mailing address:
  • Phone: 800-434-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberXM3867
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: