Provider Demographics
NPI:1003827254
Name:CLOUGH, LANA (LCSW)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:CLOUGH
Suffix:
Gender:F
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:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-0053
Mailing Address - Country:US
Mailing Address - Phone:207-324-8222
Mailing Address - Fax:
Practice Address - Street 1:200 WATERBORO RD
Practice Address - Street 2:
Practice Address - City:ALFRED
Practice Address - State:ME
Practice Address - Zip Code:04002
Practice Address - Country:US
Practice Address - Phone:207-324-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC35051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME25750099Medicaid
ME25750099Medicaid