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NPI Code Detail

MEDICARE: PAM B. SMITH LCPC

MEDICARE: PAM B. SMITH 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
1101Y00000XCounselorCC1655ME

General Provider Information

NPI Number : 1376508614
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAM B. SMITH LCPC
Provider Business Mailing Address
First Line : 306 MAINE ST
Second Line :
City : BRUNSWICK
State : ME
Zip : 04011-3314
Country : US
Telephone Number : 207-373-1237
Fax Number :
Provider Business Practice Location Address
First Line : 124 MAIN ST
Second Line :
City : TOPSHAM
State : ME
Zip : 04086-1221
Country : US
Telephone Number : 207-373-1237
Fax Number : 207-373-1237
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2006
Last Update Date : 11/20/2007

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