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General NPI Number Information
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NPI Number | 1760544522
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Entity Type | Individual
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Provider Name | MARGARET DEROSE BRAGA LCPC, LSW
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 254 WESTERN AVE
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2410
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Country | US
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Telephone | 207-661-0440
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Fax | 207-661-0444
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Provider Business Mailing Address
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Address Line | 190 RIVERSIDE ST UNIT 6B
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City | PORTLAND
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State | ME
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Zip | 04103-1073
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Country | US
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Telephone | 207-661-2000
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Fax | 207-661-2033
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | LS4051
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC1208
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License Number State | ME
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