MEDICARE: MS. DENISE JOAN BOISSE 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	104100000X	Social Worker	103K00000X	ME

General Provider Information

NPI Number	:	1902137045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENISE JOAN BOISSE LCSW

Provider Business Mailing Address
First Line	:	174 CLARKS MILL RD
Second Line	:
City	:	HOLLIS CENTER
State	:	ME
Zip	:	04042-3850
Country	:	US
Telephone Number	:	120-724-7289
Fax Number	:

Provider Business Practice Location Address
First Line	:	174 CLARKS MILL RD
Second Line	:
City	:	HOLLIS CENTER
State	:	ME
Zip	:	04042-3850
Country	:	US
Telephone Number	:	120-724-7289
Fax Number	:

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

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/28/2010

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