Provider Demographics
NPI:1437192960
Name:SLOANE, SUSAN E (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:SLOANE
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 1:142 HIGH ST
Mailing Address - Street 2:SUITE 514
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2851
Mailing Address - Country:US
Mailing Address - Phone:207-239-2908
Mailing Address - Fax:
Practice Address - Street 1:142 HIGH ST
Practice Address - Street 2:SUITE 514
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2851
Practice Address - Country:US
Practice Address - Phone:207-239-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC65461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME046103Medicare PIN
MESL ME 0461Medicare ID - Type Unspecified