Healthcare Provider Details

I. General information

NPI: 1932154234
Provider Name (Legal Business Name): MARGARET MARY ANZALONE LICSW, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 CUSHMAN RD
WINSLOW ME
04901-0751
US

IV. Provider business mailing address

435 CUSHMAN RD
WINSLOW ME
04901-0751
US

V. Phone/Fax

Practice location:
  • Phone: 978-314-4763
  • Fax:
Mailing address:
  • Phone: 978-314-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1023484
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC16304
License Number StateME

VII. Legacy identifiers

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

# 1
IdentifierLC16304
Identifier TypeOTHER
Identifier StateME
Identifier IssuerMAINE CLINICAL SOCIAL WORK LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: