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General NPI Number Information
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NPI Number | 1104501436
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Entity Type | Organization
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Legal Business Name | EMERGE & TRANSFORM
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 174 BROADWAY STE 2
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City | FARMINGTON
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State | ME
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Zip | 04938-5911
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Country | US
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Telephone | 207-860-4447
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Fax |
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Provider Business Mailing Address
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Address Line | 174 BROADWAY STE 2
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City | FARMINGTON
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State | ME
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Zip | 04938-5911
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/LCSW
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Name | MARY SMALL
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Credential | LCSW
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Telephone | 207-860-4447
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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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