Provider Demographics
NPI:1437466430
Name:GAUVIN, PENNY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:
Last Name:GAUVIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 TIBBETTS LN
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:ME
Mailing Address - Zip Code:04002-7572
Mailing Address - Country:US
Mailing Address - Phone:207-590-3668
Mailing Address - Fax:207-467-3490
Practice Address - Street 1:39 LIMERICK RD
Practice Address - Street 2:6U
Practice Address - City:ARUNDEL
Practice Address - State:ME
Practice Address - Zip Code:04046-8158
Practice Address - Country:US
Practice Address - Phone:207-590-3668
Practice Address - Fax:207-467-3490
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-12
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional