MEDICARE: SARAH A MELTZER LSWC

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	171M00000X	Case Manager/Care Coordinator	LSX10840	ME

General Provider Information

NPI Number	:	1750411161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH A MELTZER LSWC

Provider Business Mailing Address
First Line	:	899 RIVERSIDE ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-1070
Country	:	US
Telephone Number	:	207-871-1200
Fax Number	:	207-871-1232

Provider Business Practice Location Address
First Line	:	25 WESTMINSTER ST
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04240-3531
Country	:	US
Telephone Number	:	207-782-0079
Fax Number	:	207-782-2636

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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