Provider Demographics
NPI:1083628952
Name:GAYTON, VICKI LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:GAYTON
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 1:50 PARK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3176
Mailing Address - Country:US
Mailing Address - Phone:207-317-1499
Mailing Address - Fax:
Practice Address - Street 1:50 PARK RD STE 4
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3176
Practice Address - Country:US
Practice Address - Phone:207-317-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC99331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME079046OtherLCSW
ME248050099Medicaid