Healthcare Provider Details

I. General information

NPI: 1891208005
Provider Name (Legal Business Name): AMY LOUISE MARCOTTE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 MAIN ST
SPRINGVALE ME
04083-1728
US

IV. Provider business mailing address

628 MAIN ST
SPRINGVALE ME
04083-1728
US

V. Phone/Fax

Practice location:
  • Phone: 207-490-1513
  • Fax: 207-490-1609
Mailing address:
  • Phone: 207-490-1513
  • Fax: 207-490-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC7591
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: