Healthcare Provider Details

I. General information

NPI: 1124456066
Provider Name (Legal Business Name): LAUREN S B HAMPLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN S BROOKS LMSW

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 NORTH STREET 3200
WATERVILLE ME
04901-6789
US

IV. Provider business mailing address

149 NORTH STREET 3200
WATERVILLE ME
04901-6789
US

V. Phone/Fax

Practice location:
  • Phone: 207-861-3500
  • Fax: 207-861-6201
Mailing address:
  • Phone: 207-861-3500
  • Fax: 207-861-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC16780
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC16635
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: