MEDICARE: MS. PAMELA B MURTON 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	LC3359	ME

General Provider Information

NPI Number	:	1679789382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA B MURTON LCSW

Provider Business Mailing Address
First Line	:	139 WHITNEY AVE
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04102-2568
Country	:	US
Telephone Number	:	207-761-1571
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 WHITNEY AVE
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04102-2568
Country	:	US
Telephone Number	:	207-761-1571
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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