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NPI Code Detail

MEDICARE: MARTHA L VIRGIN LCSW

MEDICARE: MARTHA L VIRGIN 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
11041C0700XClinical Social WorkerLC2663ME

Other Identifiers

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

General Provider Information

NPI Number : 1568472280
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTHA L VIRGIN LCSW
Provider Business Mailing Address
First Line : 78 ATLANTIC PLACE
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-2316
Country : US
Telephone Number : 207-842-6556
Fax Number : 207-842-7773
Provider Business Practice Location Address
First Line : 12 UNITION STREET
Second Line :
City : ROCKLAND
State : ME
Zip : 04841-2739
Country : US
Telephone Number : 207-701-4402
Fax Number : 207-701-4486
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 04/01/2010

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Directions to “ MARTHA L VIRGIN LCSW” Practice Location

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