Provider Demographics
NPI:1174636880
Name:LATULIPPE, ERIN HOULIHAN (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:HOULIHAN
Last Name:LATULIPPE
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:PO BOX 1827
Mailing Address - Street 2:
Mailing Address - City:OGUNQUIT
Mailing Address - State:ME
Mailing Address - Zip Code:03907-1827
Mailing Address - Country:US
Mailing Address - Phone:207-415-8512
Mailing Address - Fax:
Practice Address - Street 1:48 BLUE HERON PL.
Practice Address - Street 2:
Practice Address - City:OGUNQUIT
Practice Address - State:ME
Practice Address - Zip Code:03907-1827
Practice Address - Country:US
Practice Address - Phone:207-415-8512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC73121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME273940099Medicaid