Provider Demographics
NPI:1164644688
Name:CIANCHETTE, LAURA L (LMFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:L
Last Name:CIANCHETTE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 GRAY STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-400-1611
Mailing Address - Fax:
Practice Address - Street 1:1486B BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2602
Practice Address - Country:US
Practice Address - Phone:207-400-1611
Practice Address - Fax:207-772-8505
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF1730106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist