MEDICARE: MRS. ELIZABETH M DAIGLE LCPC-C, CADC

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	104100000X	Social Worker	LSX12762	ME
2	101YM0800X	Mental Health Counselor	XL4111	ME
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAC5239	ME

General Provider Information

NPI Number	:	1780985960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH M DAIGLE LCPC-C, CADC

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

Provider Business Practice Location Address
First Line	:	4 PARK ST
Second Line	:	SUITE 2
City	:	LEWISTON
State	:	ME
Zip	:	04240-7172
Country	:	US
Telephone Number	:	207-784-0922
Fax Number	:

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	06/20/2014

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