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General NPI Number Information
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NPI Number | 1053887737
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Entity Type | Organization
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Legal Business Name | LIFEWORKS OF MAINE LLC
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Dates
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Enumeration Date | 10/19/2018
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Last Update Date | 10/19/2018
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Provider Practice Location Address
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Address Line | 444 STILLWATER AVE STE 103
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City | BANGOR
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State | ME
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Zip | 04401-3500
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Country | US
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Telephone | 120-307-7886
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Fax |
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Provider Business Mailing Address
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Address Line | 444 STILLWATER AVE STE 103
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City | BANGOR
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State | ME
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Zip | 04401-3500
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Country | US
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Telephone | 207-307-7886
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Fax | 207-433-1241
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. HEATHER L MACDUFFIE
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Credential | PHD LCSW
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Telephone | 207-307-7886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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