Provider Demographics
NPI:1174689947
Name:DEVEAU, TAMMY L (LMSW-CC)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:L
Last Name:DEVEAU
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HATCH DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-2159
Mailing Address - Country:US
Mailing Address - Phone:207-492-1653
Mailing Address - Fax:207-492-1633
Practice Address - Street 1:7 HATCH DR
Practice Address - Street 2:SUITE 290
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2159
Practice Address - Country:US
Practice Address - Phone:207-492-1653
Practice Address - Fax:207-492-1633
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC10786104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4324320299Medicaid
ME098153OtherANTHEM BCBS NUMBER