Healthcare Provider Details

I. General information

NPI: 1619660727
Provider Name (Legal Business Name): JUNE MIDURA LC25078
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 TANDBERG TRL
WINDHAM ME
04062-5841
US

IV. Provider business mailing address

86 TANDBERG TRL
WINDHAM ME
04062-5841
US

V. Phone/Fax

Practice location:
  • Phone: 207-893-0386
  • Fax:
Mailing address:
  • Phone: 207-893-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC25078
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: