Provider Demographics
NPI:1376759456
Name:PETRINI, MARY ELIZABETH (LCPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:PETRINI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 TOWN FARM RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-4206
Mailing Address - Country:US
Mailing Address - Phone:207-446-7567
Mailing Address - Fax:207-620-8595
Practice Address - Street 1:86 WINTHROP ST STE 3
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5566
Practice Address - Country:US
Practice Address - Phone:207-446-7567
Practice Address - Fax:207-620-8595
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MEXL3670104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional