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General NPI Number Information
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NPI Number | 1659391886
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Entity Type | Individual
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Provider Name | ERVIN W LORD LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 60 FRONT ST
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City | WATERVILLE
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State | ME
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Zip | 04901-6658
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Country | US
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Telephone | 207-649-1098
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6400
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City | CHINA VILLAGE
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State | ME
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Zip | 04926-0400
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Country | US
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Telephone | 207-649-1098
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LC6939
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License Number State | ME
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