Healthcare Provider Details

I. General information

NPI: 1962819953
Provider Name (Legal Business Name): EMILY SHAYNA OSTROW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MAIN ST SUITE 202
SPRINGVALE ME
04083-1870
US

IV. Provider business mailing address

469 MAIN ST SUITE 202
SPRINGVALE ME
04083-1870
US

V. Phone/Fax

Practice location:
  • Phone: 207-490-6600
  • Fax: 207-490-6603
Mailing address:
  • Phone: 207-490-6600
  • Fax: 207-490-6603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC14764
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116664
License Number StateMA

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: