=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548592652
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA G STROUT LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2010
-----------------------------------------------------
Last Update Date | 02/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 449 FOREST AVE STE 211
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04101-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-891-6534
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 ROBINHOOD RD
-----------------------------------------------------
City | CAPE ELIZABETH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04107-1815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-891-6534
-----------------------------------------------------
Fax | 888-492-0305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LC6300
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------