Provider Demographics
NPI:1003257825
Name:THURLOW, MARK (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:THURLOW
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:WINN
Mailing Address - State:ME
Mailing Address - Zip Code:04495-5329
Mailing Address - Country:US
Mailing Address - Phone:207-738-3032
Mailing Address - Fax:
Practice Address - Street 1:21 NORTH RD
Practice Address - Street 2:
Practice Address - City:WINN
Practice Address - State:ME
Practice Address - Zip Code:04495-5329
Practice Address - Country:US
Practice Address - Phone:207-738-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC142211041C0700X
MELC153931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical