Healthcare Provider Details

I. General information

NPI: 1861421182
Provider Name (Legal Business Name): MARSHA B PILZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CLARK POINT RD
SOUTHWEST HARBOR ME
04679-4415
US

IV. Provider business mailing address

95 FREEMAN RIDGE RD P.O. BOX 723
SOUTHWEST HARBOR ME
04679-4235
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-3189
  • Fax:
Mailing address:
  • Phone: 207-244-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC7182
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: