MEDICARE: NANCY ANN LUDWIG LCSW/LADC/CCS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LC782	ME
2	1041C0700X	Clinical Social Worker	LC3360	ME

General Provider Information

NPI Number	:	1568651453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY ANN LUDWIG LCSW/LADC/CCS

Provider Business Mailing Address
First Line	:	4 PARK ST
Second Line	:	SUITE 1
City	:	LEWISTON
State	:	ME
Zip	:	04240-7172
Country	:	US
Telephone Number	:	207-784-0922
Fax Number	:	207-784-6143

Provider Business Practice Location Address
First Line	:	4 PARK ST
Second Line	:	SUITE 1
City	:	LEWISTON
State	:	ME
Zip	:	04240-7172
Country	:	US
Telephone Number	:	207-784-0922
Fax Number	:	207-784-6143

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

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	10/17/2007

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