MEDICARE: MS. CHRISTINA FAY 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	LC4524	ME
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	CCS4684	ME
3	1041C0700X	Clinical Social Worker	LC11294	ME

General Provider Information

NPI Number	:	1861704488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINA FAY LCSW, LADC, CCS

Provider Business Mailing Address
First Line	:	140 SAND BAR RD
Second Line	:
City	:	WINDHAM
State	:	ME
Zip	:	04062-5540
Country	:	US
Telephone Number	:	207-281-2681
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 BISHOP ST STE 3
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-2681
Country	:	US
Telephone Number	:	207-281-2681
Fax Number	:

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

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	11/14/2023

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