MEDICARE: CLAIRE OPPENHEIM LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1144466152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAIRE OPPENHEIM LLC

Provider Business Mailing Address
First Line	:	75 PEARL ST
Second Line	:	SUITE 410
City	:	PORTLAND
State	:	ME
Zip	:	04101-4101
Country	:	US
Telephone Number	:	207-773-0050
Fax Number	:	207-828-1489

Provider Business Practice Location Address
First Line	:	75 PEARL ST
Second Line	:	SUITE 410
City	:	PORTLAND
State	:	ME
Zip	:	04101-4101
Country	:	US
Telephone Number	:	207-773-0050
Fax Number	:	207-828-1489

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CLAIRE OPPENHEIM
Credential	:	LCSW
Telephone Number	:	207-773-0050

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	12/22/2008

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