Provider Demographics
NPI:1407104219
Name:ARTHURS, MICHELLE ALLISON
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALLISON
Last Name:ARTHURS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-1175
Mailing Address - Country:US
Mailing Address - Phone:207-794-4858
Mailing Address - Fax:
Practice Address - Street 1:27 BOYD STREET
Practice Address - Street 2:
Practice Address - City:MATTAWAMKEAG
Practice Address - State:ME
Practice Address - Zip Code:04459-0273
Practice Address - Country:US
Practice Address - Phone:207-794-4858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC136381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1407104219Medicaid