Healthcare Provider Details

I. General information

NPI: 1891703674
Provider Name (Legal Business Name): AUDREY J YEATON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 US ROUTE 1 SUITE 215
YORK ME
03909-1659
US

IV. Provider business mailing address

433 US ROUTE 1 SUITE 215
YORK ME
03909-1659
US

V. Phone/Fax

Practice location:
  • Phone: 207-337-5507
  • Fax: 207-351-1975
Mailing address:
  • Phone: 207-337-5507
  • Fax: 207-351-1975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC11472
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: