Provider Demographics
NPI:1356688790
Name:GROO, LISA TOBEY (LCPC, CADC, MHRT-CSP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:TOBEY
Last Name:GROO
Suffix:
Gender:F
Credentials:LCPC, CADC, MHRT-CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ACADEMY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3183
Mailing Address - Country:US
Mailing Address - Phone:207-554-2352
Mailing Address - Fax:207-554-2351
Practice Address - Street 1:406 STATE ST STE 2
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3331
Practice Address - Country:US
Practice Address - Phone:207-412-0973
Practice Address - Fax:207-412-0806
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6747101Y00000X
MECC4620101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010276859Medicaid