Provider Demographics
NPI:1003946757
Name:LAVERRIERE, MARIE A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:A
Last Name:LAVERRIERE
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 1:95 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9210
Mailing Address - Country:US
Mailing Address - Phone:207-205-2521
Mailing Address - Fax:
Practice Address - Street 1:95 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9210
Practice Address - Country:US
Practice Address - Phone:207-205-2521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NML#1-07338101Y00000X
NMX-068291041C0700X
MELC107081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor