Provider Demographics
NPI:1275786683
Name:TRIPP, SHENAUGH (LCSW)
Entity Type:Individual
Prefix:
First Name:SHENAUGH
Middle Name:
Last Name:TRIPP
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 1:200 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2831
Mailing Address - Country:US
Mailing Address - Phone:207-671-7285
Mailing Address - Fax:
Practice Address - Street 1:200 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2831
Practice Address - Country:US
Practice Address - Phone:207-671-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC73601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical