1275690398 NPI number — MS. NANCY MARIE PLOUFFE LCSW

Table of content: DR. RICHARD H PATT M.D. (NPI 1558356758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275690398 NPI number — MS. NANCY MARIE PLOUFFE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLOUFFE
Provider First Name:
NANCY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275690398
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE HILL
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04614-1102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-374-2296
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 MINES RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE HILL
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-374-2296
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2007

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: 1041C0700X , with the licence number:  LC3637 , 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)

  • Identifier: 7406163 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 026262 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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