Provider Demographics
NPI:1407948896
Name:WEIGEL, THERESA JOAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:JOAN
Last Name:WEIGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:JOAN
Other - Last Name:BICKFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:P.O. 1161
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614
Mailing Address - Country:US
Mailing Address - Phone:207-374-5780
Mailing Address - Fax:207-374-5780
Practice Address - Street 1:6 MINES ROAD
Practice Address - Street 2:SUITE I
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614
Practice Address - Country:US
Practice Address - Phone:207-374-5780
Practice Address - Fax:207-374-5780
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC35761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7296Medicare Oscar/Certification