Provider Demographics
NPI:1417605437
Name:CRONIN, LAURIE JEAN (CADC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEAN
Last Name:CRONIN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 NELLIGAN DR
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429-7106
Mailing Address - Country:US
Mailing Address - Phone:207-852-1410
Mailing Address - Fax:
Practice Address - Street 1:760 UNION ST STE A
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3125
Practice Address - Country:US
Practice Address - Phone:207-989-2946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC7176101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)