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General NPI Number Information
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NPI Number | 1740622836
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Entity Type | Individual
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Provider Name | KEVIN GARNER SAMPLE LCSW, LADC
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Gender | Female
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Dates
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Enumeration Date | 07/18/2013
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | EASTPORT HEALTH CARE 30 BOYNTON STREET
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City | EASTPORT
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State | ME
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Zip | 04631
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Country | US
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Telephone | 207-853-0185
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Fax | 207-853-4248
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Provider Business Mailing Address
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Address Line | PO BOX 630
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City | CALAIS
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State | ME
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Zip | 04619-0630
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Country | US
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Telephone | 207-751-8712
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Fax | 207-454-0775
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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 | LC15430
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License Number State | ME
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