Provider Demographics
NPI:1073638037
Name:MACOMBER, SEANNA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SEANNA
Middle Name:MARIE
Last Name:MACOMBER
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 1:739 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-5606
Mailing Address - Country:US
Mailing Address - Phone:207-266-6688
Mailing Address - Fax:
Practice Address - Street 1:970 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2722
Practice Address - Country:US
Practice Address - Phone:207-945-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC114611041C0700X
MECAC5276101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)