Provider Demographics
NPI:1003143900
Name:AMES, TERAH R (LCSW, LADC)
Entity Type:Individual
Prefix:
First Name:TERAH
Middle Name:R
Last Name:AMES
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5462
Mailing Address - Country:US
Mailing Address - Phone:207-874-1045
Mailing Address - Fax:207-767-0995
Practice Address - Street 1:525 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5462
Practice Address - Country:US
Practice Address - Phone:207-874-1045
Practice Address - Fax:207-767-0995
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4155101YA0400X
MELC145021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432875799Medicaid
MEE400123430Medicare PIN