Healthcare Provider Details

I. General information

NPI: 1568422020
Provider Name (Legal Business Name): MERYL GOLOVIN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 US ROUTE 1
SCARBOROUGH ME
04074-9617
US

IV. Provider business mailing address

18 EQUESTRIAN WAY
SCARBOROUGH ME
04074-9631
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-6745
  • Fax: 207-883-6745
Mailing address:
  • Phone: 207-883-6745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCC2849
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: