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General NPI Number Information
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NPI Number | 1750770152
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Entity Type | Individual
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Provider Name | LARISSA J BROWN LMFT-C
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Gender | Female
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 86 MAIN SREET SUITE 302
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City | AUBURN
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State | ME
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Zip | 04210
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Country | US
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Telephone | 207-240-5441
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Fax |
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Provider Business Mailing Address
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Address Line | 38 MECHANIC FALLS RD
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City | POLAND
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State | ME
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Zip | 04274-6540
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Country | US
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Telephone | 207-240-5441
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | XM4408
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License Number State | ME
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