Provider Demographics
NPI:1457318263
Name:HINCKLEY, SANDRA J (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:HINCKLEY
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 1:229 MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3905
Mailing Address - Country:US
Mailing Address - Phone:207-899-0366
Mailing Address - Fax:
Practice Address - Street 1:67 SHAKER RD STE 7
Practice Address - Street 2:CHRISTOPHER AARON COUNSELING CENTER
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04072-1536
Practice Address - Country:US
Practice Address - Phone:204-294-4657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC51641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME319280099Medicaid
MEMM9566Medicare ID - Type Unspecified