Provider Demographics
NPI:1437260635
Name:WHITESIDE, NANCY DARROW (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:DARROW
Last Name:WHITESIDE
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 1:39 BARIBEAU DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWIEK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:39 BARIBEAU DRIVE
Practice Address - Street 2:
Practice Address - City:BRUNSWIEK
Practice Address - State:ME
Practice Address - Zip Code:04011-3242
Practice Address - Country:US
Practice Address - Phone:207-721-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4199104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEK006501OtherANTHEM
MM8037Medicare ID - Type Unspecified