Provider Demographics
NPI:1407889900
Name:CUTHBERTSON, NANCY MARION (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:MARION
Last Name:CUTHBERTSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:OLD ORCHARD
Mailing Address - State:ME
Mailing Address - Zip Code:04064
Mailing Address - Country:US
Mailing Address - Phone:207-934-5858
Mailing Address - Fax:207-934-6111
Practice Address - Street 1:7 OAK HILL TERRACE
Practice Address - Street 2:SUITE 9
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-233-8975
Practice Address - Fax:207-934-6111
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC113991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433423099Medicaid
ME433423099Medicaid