Provider Demographics
NPI:1407164676
Name:STAPLES, VICKIE L (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:L
Last Name:STAPLES
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-1134
Mailing Address - Country:US
Mailing Address - Phone:207-431-4456
Mailing Address - Fax:
Practice Address - Street 1:100 W FRONT ST
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1134
Practice Address - Country:US
Practice Address - Phone:207-431-4456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC12128104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker