MEDICARE: LISA ELLEN HASKINS LCPC

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	CC1295	ME

General Provider Information

NPI Number	:	1154532760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ELLEN HASKINS LCPC

Provider Business Mailing Address
First Line	:	PO BOX 11
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-0011
Country	:	US
Telephone Number	:	207-837-8691
Fax Number	:	207-833-2445

Provider Business Practice Location Address
First Line	:	98 MAINE ST
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-2031
Country	:	US
Telephone Number	:	207-837-8691
Fax Number	:	207-833-2445

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

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	11/10/2008

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