Provider Demographics
NPI:1326352147
Name:REMICK, PENNY LEE (LCPC)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:LEE
Last Name:REMICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:LEE
Other - Last Name:REMICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:25A JUNE ST STE 113
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-2642
Mailing Address - Country:US
Mailing Address - Phone:207-490-7374
Mailing Address - Fax:
Practice Address - Street 1:25A JUNE ST STE 113
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2642
Practice Address - Country:US
Practice Address - Phone:207-490-7374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH599101YM0800X
MECC4318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health