Provider Demographics
NPI:1275057309
Name:CULBERSON, ELLEN ROSE POGSON (LCSW)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ROSE POGSON
Last Name:CULBERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:R
Other - Last Name:POGSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:100 CAMPUS AVE STE A&B
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6040
Practice Address - Country:US
Practice Address - Phone:207-755-3434
Practice Address - Fax:207-784-6826
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC16765104100000X
MELC181861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker