Provider Demographics
NPI:1184230047
Name:FERN, LORRAINE (LCSW)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:FERN
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 1:52 COVE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2514
Mailing Address - Country:US
Mailing Address - Phone:207-956-5977
Mailing Address - Fax:
Practice Address - Street 1:1 CONSTELLATION WAY STE 101
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2256
Practice Address - Country:US
Practice Address - Phone:207-956-5977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC175831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical