Provider Demographics
NPI:1164874137
Name:NANCY M PLOUFFE, LLC
Entity Type:Organization
Organization Name:NANCY M PLOUFFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOUFFE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-374-2296
Mailing Address - Street 1:PO BOX 1102
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-1102
Mailing Address - Country:US
Mailing Address - Phone:207-632-4528
Mailing Address - Fax:
Practice Address - Street 1:6 MINES RD
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-6408
Practice Address - Country:US
Practice Address - Phone:207-632-4528
Practice Address - Fax:207-374-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC36371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME026262OtherANTHEM BLUE CROSS
ME7406163OtherAETNA
ME7406163OtherAETNA