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General NPI Number Information
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NPI Number | 1275923369
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Entity Type | Organization
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Legal Business Name | THEPLEASANTOAK, INC
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 11 PARKWOOD DR
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City | AUGUSTA
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State | ME
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Zip | 04330-6252
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Country | US
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Telephone | 207-441-6624
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Fax |
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Provider Business Mailing Address
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Address Line | 11 PARKWOOD DR
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City | AUGUSTA
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State | ME
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Zip | 04330-6252
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Country | US
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Telephone | 207-441-6624
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | SUSAN A BROCHU
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Credential | LCSW
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Telephone | 207-441-6624
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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 | LC7597
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License Number State | ME
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