Provider Demographics
NPI:1407018153
Name:YORK-LONGPRE, TIBBY (LADC)
Entity Type:Individual
Prefix:
First Name:TIBBY
Middle Name:
Last Name:YORK-LONGPRE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LISBON ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7198
Mailing Address - Country:US
Mailing Address - Phone:207-783-3574
Mailing Address - Fax:
Practice Address - Street 1:11 LISBON ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7198
Practice Address - Country:US
Practice Address - Phone:207-783-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2470101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432018999Medicaid