MEDICARE: MISS HEIDI DAWN MACVANE 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	1041C0700X	Clinical Social Worker	LC10874	ME

General Provider Information

NPI Number	:	1205162666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS HEIDI DAWN MACVANE LCSW

Provider Business Mailing Address
First Line	:	38 FALCOLN DR.
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210
Country	:	US
Telephone Number	:	617-230-0896
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 FALCON DR
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210-4384
Country	:	US
Telephone Number	:	617-230-0896
Fax Number	:

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

Provider Enumeration Date	:	10/20/2009
Last Update Date	:	10/20/2009

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