1932274859 NPI number — MRS. MARIETTE MARIE HANLON LCSW

Table of content: MRS. MARIETTE MARIE HANLON LCSW (NPI 1932274859)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932274859 NPI number — MRS. MARIETTE MARIE HANLON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANLON
Provider First Name:
MARIETTE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ST PIERRE
Provider Other First Name:
MARIETTE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932274859
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 FARWELL STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LISBON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-353-8118
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 FARWELL STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LISBON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-353-8118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  ME157503 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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