MEDICARE: CAROLYN SUGGS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC7697	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124110267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN SUGGS LCSW

Provider Business Mailing Address
First Line	:	186 S RICHLAND ST
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-4728
Country	:	US
Telephone Number	:	207-409-6441
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 SHORE RD
Second Line	:	BLDG # 326
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-1916
Country	:	US
Telephone Number	:	207-409-6441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	05/22/2012

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