Provider Demographics
NPI:1073560819
Name:BROPHY, LAURIE A (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:BROPHY
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 1:111 BURLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:STETSON
Mailing Address - State:ME
Mailing Address - Zip Code:04488-3326
Mailing Address - Country:US
Mailing Address - Phone:207-356-4067
Mailing Address - Fax:
Practice Address - Street 1:46 BETTON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-2636
Practice Address - Country:US
Practice Address - Phone:207-356-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC112601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431896599Medicaid
ME098304OtherANTHEM LEGACY NUMBER