Provider Demographics
NPI:1265660781
Name:HAMLIN, SHARON CLOUGH
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:CLOUGH
Last Name:HAMLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:ME
Mailing Address - Zip Code:04344
Mailing Address - Country:US
Mailing Address - Phone:207-582-5192
Mailing Address - Fax:207-582-5192
Practice Address - Street 1:268 MAINE AVE
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:ME
Practice Address - Zip Code:04344-4514
Practice Address - Country:US
Practice Address - Phone:207-582-5192
Practice Address - Fax:207-582-5192
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS2960320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME203680000OtherPROVIDER NUMBER