Healthcare Provider Details

I. General information

NPI: 1174785430
Provider Name (Legal Business Name): CANDACE M MARRINER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 SILVER ST
WATERVILLE ME
04901-5923
US

IV. Provider business mailing address

PO BOX 5
BUCKSPORT ME
04416-0005
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-4253
  • Fax:
Mailing address:
  • Phone: 207-945-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC12959
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: