Provider Demographics
NPI:1083708887
Name:SIROTA, JOYCE (LCSW)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:SIROTA
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 1:29 SIROTA DR
Mailing Address - Street 2:
Mailing Address - City:SEARSMONT
Mailing Address - State:ME
Mailing Address - Zip Code:04973-3323
Mailing Address - Country:US
Mailing Address - Phone:207-322-7572
Mailing Address - Fax:
Practice Address - Street 1:29 SIROTA DR
Practice Address - Street 2:
Practice Address - City:SEARSMONT
Practice Address - State:ME
Practice Address - Zip Code:04973-3323
Practice Address - Country:US
Practice Address - Phone:207-230-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC76601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431506799Medicaid
MEMM833603Medicare PIN