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General NPI Number Information
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NPI Number | 1518484898
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Entity Type | Individual
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Provider Name | DENISE M THORN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 07/10/2018
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Provider Practice Location Address
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Address Line | 100 CAMPUS AVE STE A&B
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City | LEWISTON
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State | ME
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Zip | 04240
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Country | US
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Telephone | 207-755-3434
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Fax | 207-784-6826
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Provider Business Mailing Address
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Address Line | PO BOX 7291
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City | LEWISTON
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State | ME
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Zip | 04243-7291
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Country | US
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Telephone | 207-777-8553
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Fax | 207-777-8800
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MC15756
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | MC15756
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License Number State | ME
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