Healthcare Provider Details

I. General information

NPI: 1184693756
Provider Name (Legal Business Name): MIA LYNN FOLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 MAIN ST SUITE 3
SANFORD ME
04073-3586
US

IV. Provider business mailing address

908 MAIN ST SUITE 3
SANFORD ME
04073-3586
US

V. Phone/Fax

Practice location:
  • Phone: 603-531-1407
  • Fax:
Mailing address:
  • Phone: 603-531-1407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC15054
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: