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General NPI Number Information
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NPI Number | 1679801112
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Entity Type | Individual
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Provider Name | CARRIE LOUISE ROBERTS LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/20/2009
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 50 FOREST FALLS DR STE 3
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City | YARMOUTH
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State | ME
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Zip | 04096-6937
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Country | US
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Telephone | 207-712-8504
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Fax | 207-536-5937
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Provider Business Mailing Address
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Address Line | 50 FOREST FALLS DR STE 3
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City | YARMOUTH
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State | ME
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Zip | 04096-6937
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Country | US
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Telephone | 207-712-8504
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Fax | 207-536-5937
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC13286
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAC4688
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License Number State | ME
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