Provider Demographics
NPI:1407845027
Name:POISSON, MICHELLE E (LCSW, CCS)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:E
Last Name:POISSON
Suffix:
Gender:F
Credentials:LCSW, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 MAIN ST STE 150
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04294-3056
Mailing Address - Country:US
Mailing Address - Phone:207-645-2913
Mailing Address - Fax:207-645-2983
Practice Address - Street 1:284 MAIN ST STE 150
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294-3056
Practice Address - Country:US
Practice Address - Phone:207-645-2913
Practice Address - Fax:207-645-2983
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC101701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical